Snakebites!

---

Intro

Linda : Today we have Nick Brande Hoff, Dr. Nick Brand Hoff who is a snake bite expert from the Sleepies snake Bite Foundation. Nick, tell me a little bit about why you are a snake bite expert.

Nick2: I am I’m an emergency physician, a medical toxicologist who focuses on snake bite research. And clinical training and work with the as Escapia Snake Bite Foundation to sort of promote the education and training of snake bite care.

I also work with a really fabulous ology team within the foundation to focus on sort of the biology and nomics or the venom variation of different snakes around the world.

Linda : So, a couple weeks ago we were out riding in outside of Tucson, Arizona, on the backside of Mount. And we were about an hour drive down in a Jeep Road.

That was a pretty rugged road. And then we had taken the bikes off and then rode down down to this farming area, which there was [00:01:00] nobody out there. So we were probably about an hour down a hill coming back up. And I saw a really large rattlesnake and it got pretty close to me. It was coiled up, so I was pretty surprised by.

But what I kept thinking about afterwards was, what happens if I would’ve gotten bit by the snake because we had no cell reception where there’s two of us were carrying a Garmin inReach device. With SOS capability and satellite text. And so we really didn’t know what we should have done. So you’re the snake bite expert.

So tell me what would you have done if you were out there and you had gotten bitten by the snake?

The Answer

Nick2: So this is not an uncommon scenario to sort of see snakes in remote locations. If a bite were to occur and you were concerned about it being a venomous snake in this case, probably a rattlesnake given where you were at the first thing to do to be, to sort of get to safety, [00:02:00] Now most people think that means like pedaling miles and miles away from the snake, but really the snake doesn’t wanna be around you.

It usually strikes as the last resort. And so safety is a few feet away, at least from the snake. Getting to safety and then minimizing any movement of the bit extremity. And so we often have people sort of sit down on the ground. And try to keep, whether it’s the hand or a leg.

Try to keep it from moving because the venom travels through the lymphatic system. As your muscles squeeze, there’s more flow occurring and so you wanna try to minimize the spread of the venom. And so we, we have people sit down, we’d have them take off any constricting clothing. And so if it’s an upper extremity, you think rings, watches bracelets, et cetera.

Lower extremity feet are the most common bit areas. So take your shoes off, take your socks off if you have any stockings on, or if you use any compression socks or anything like that, it’s probably best to take [00:03:00] those off as well.

Swelling

Linda : So what I hear you saying is the first step is to really think through that. My body’s probably gonna swell up in, in the part, the area that I got bit, so I need to really think that through. Is it my whole body was, do I think it’s gonna swell up or is it just my, like if I got bit on my hand, I take my rings off.

Nick2: It would be the, it’d be the whatever extremity got bitten. So if it’s your left hand, take everything off your left arm basically. If it were your right leg, take everything off your right leg. It’s not, your whole body’s not gonna swell, it’s just the extremities gonna itself.

Linda : Okay.

Cell Phone / Garmin inReach

Nick2: so after you are in a safe position and you have everything off your extremities trying to, it sounds like you were in a remote area with no cell phone service. If you had cell phone service, he called nine one one immediately.

And try to get educated the sort of proliferation of the inReach garments and the spot devices and other sos devices has really [00:04:00] been a game changer in these scenarios. So really activating that because this is a medical emergency you may have no symptoms. You may have really rapidly progressing symptoms, and sometimes those rapidly progressing symptoms can be very delayed.

And so it could take some, it could take some time to start to, to feel those. And so you don’t want to be in the middle of nowhere waiting it out if you’ll, so I would activate the inReach in this case and get emergency systems out too as soon as possible so they can. Assess you, treat you accordingly and get you to the nearest hospital

No inReach

Linda : what would I do if I didn’t have any kind of communications? What should I be doing? Should I just hang out and wait? Or should I just be trying as the best I can to try to get back to my vehicle?

Nick2: Yeah, so this is This is a more difficult scenario. If you’re with somebody, you would hopefully have them while you are remaining, still [00:05:00] have them get to a supply service or some other service could be reached rapidly while you are sort of not moving. The real difficult scenario occurs if you’re alone.

If you’re alone, you may need to hike, bike. Do whatever you need to do in order to get out to a place where you can get help. Find another hi a biker or whatever needs to occur.

Linda – clarification

Linda : So I wanna be really specific in the scenario that we just described. So are you telling me that, let’s say I was the one to get bit that we would send. Evan ahead to try to get some emergency help or do you think that he should stay with me and try and both of us get out even though it’s gonna be about an hour bike ride out?

Nick2: I think in this specific scenario, if the inReach was functional and you could have the SOS sent out through the inReach system, I would have Kevin stay with you. Um, Activate the sos [00:06:00] system and then wait until emergency medical systems arrived.

How long to reach?

Linda : And how long do you think that would take for them to reach us?

Nick2: I mean, that, that’s highly dependent on where you’re located.

Linda : Yeah, exactly.

Nick2: Some of these usually in this scenario, they would send out a helicopter but depending on which sort of path or road you are, they may have a local ranger or other service vehicle nearby that may be able to drive out to you as well.

Recap

Linda : So to recap, what I hear you saying is that we should use our sos try to state, where we are, and then hope that they’re gonna fly a helicopter out to, to reach us. Is that correct?

Nick2: Yeah, helicopter, local service vehicle if they can get you before the helicopter. But you know, however, the EMS system functions in that region. Your best bet is to stay still in, in one location.

Without inReach Device

Linda : But if I’m by myself and I don’t have any way of communications, my [00:07:00] best bet is to try to get out, to not stay still because I have no way of communicating with any anybody Correct.

Nick2: Yes. There’s no that’s, that’s the ultimate. Sort of risk benefit of you may have progression of your symptoms faster if you are using the limb, but at the same time you do need to get help immediately. And so trying to figure that out, if it’s if it’s an upper extremity bite, you try to keep that still maybe while you’re hiking or biking out.

If it’s at a lower extremity, you bike. That’s obviously a much hard. Um, Lynn to isolate in those scenarios, but you just gotta get to a point where you can get help.

Follow Up Questions

Linda : Now we’re gonna go into some follow up questions. Tell me about in the United States, how many people really get bit by rattlesnakes in a year?

Nick2: So it’s on average, it’s approximately 9,000 bites per year. That’s all venomous snakes in the US And so you’re talking your pit [00:08:00] vipers, which include rattlesnakes are the vast majority of envenomations. Um, So syncs, copperheads, and cotton mouths. And then there’s about a hundred bytes a. Of coral snakes and then about a hundred bites a year of exotic snakes that are sort of captive, and that’s a very different scenario.

Linda : And in the Rattlesnake category. So we’re thinking about my scenario. What’s my percentage chance of actually survival? Do? Is it really low or is it high? If we do absolutely nothing and I get bit by a snake, will it kill me by a rattlesnake? Let me be specific.

Nick2: It’s possible. There’s 9,000 bites per year. There’s only about three to five deaths per year in the United States. And so the chance of you dying from rattlesnake bites pretty low.

But the back, back in the late 18 hundreds, early 19 hundreds, there were reports of mortalities as high as 50% from Rattlesnake and invents. [00:09:00] Um, Now with, even without getting antivenom, just basic supportive care would drastically reduce that.

And then you throw antivenom on top of that. And we have two very effective antivenoms in United States. Deaths are really rare. Here.

Linda : That’s great. So, have you heard of many cyclists getting bit by rattles?

Nick2: It’s not common just due to sort of being more elevated and moving more rapidly on trails. But I have heard of, I have heard of for some cyclists it’s like I said maybe one or two a year, not a. That I hear about it Now, there may be more that I’m unaware of, but it’s not a, it’s not a regular event.

Linda : That’s great to know. I know a lot of people are really afraid of rattlesnakes and I certainly, when I saw the one that we did, I was impressed and also stepped back and said, okay everything now that I see looks like a rattlesnake. So it was kind [00:10:00] of funny. . So when I get bit by a rattlesnake, wh you, you talk about your body swelling, but tell me about what really happens to your body.

You don’t have to go through the medical terms, but what can I expect? You said there’s a, people react differently, but tell me, kind of give us the range.

Nick2: The venom compositions of different species and even within the same species of rattlesnake can vary. And so based on what that composition is, will be depending on what symptoms. You develop the vast majority of rattle, think, and venom involve local pain, local swelling, maybe bleeding at the bite site.

You can get sort of, metallic taste and some numbness around your mouth is quite common. There are more severe envenomations where sort of more systemic or widespread and ve uh, signs are gonna occur. So you can get nausea, you can get some vomiting, you might get a headache, sometimes you get a little blood pressure.

And so it’s pretty rare. [00:11:00] To have more systemic symptoms. And then even more rare is sort of a rapid progression of something similar to anaphylaxis. So airways, swelling low blood pressure rash, things of that nature. Something that’s more life threaten.

Linda : Interesting. So I was really surprised when I went on to your website what one of the first things you had me do was to take off my jewelry. And I think I, if I remember reading it, said, don’t get out the knife and start trying to suck the venom out, out of the bite site. Is that correct? Are there other misconceptions that you wanna make sure that our listeners hear.

Nick2: Yeah, so there’s all sorts of things that are sold or that we learned from grandpa while we’re out. Out fishing or hunting or whatever that are just not accurate anymore. And so a lot of people, the learn the cut and suck method, that’s not helpful. The [00:12:00] Sawyer extractor, which is kind of like a suction device, but they sell at R e I and EMS and a whole bunch of other outdoor stores, not helpful at all and potentially harmful.

There’s often circulation on social media about using Benadryl and other medications. None of it. None of that is helpful. There’s no proven benefit. The worst that I’ve heard is people using tasers cuz they think that the electricity will denature the venom proteins.

I’ve had two separate occasions where I’ve had farmers get bitten and then connect the jumper cables to their F two 50 s and shock themselves. And so now you’re dealing with an electrodermal injury on top of a snake bite. It’s just not good for anybody. And so, it’s basically if you get bitten, isolate the extremity, don’t use it, put it at the level of the heart take off any constricting devices on that extremity and get help and [00:13:00] get to a hospital as quick as you can.

Everything else beyond that is not helpful and may potentially be harmful to.

Linda : I think the whole idea. Of shocking myself with my car battery would never have come to my imagination to do that, especially if I had just gotten bit by a snake. But it is amazing. Every time I’ve talked to somebody recently, I’ve said, Hey, I’m gonna interview this guy about rattlesnakes.

And they’re all like I carry a knife . I’m like, okay. So you’re saying definitely do not start slicing open the wound to suck the vem out.

Nick2: Yeah, doing, adding a adding a bigger wound to an area that potentially has been a minute that causes you to bleed much easier is a bad idea.

Linda : Okay, great. So tell me about rattlesnakes. Do they are uh, do they hibernate? What time of the day are they typically out? Tell me a little bit about rattles li little bit more about rattlesnakes and where are they? Where, Where are they gonna be hanging out?

Nick2: Yeah, [00:14:00] sure. So, rattle sinks are cold blooded animals. They bromate in the winter or they, they hibernate and they go, they have a den. So they’re actually very specific to their den site. They don’t hop around from den to den each year. They all go. To their, sort of their base home.

During the spring, they, as it starts to warm up, they start to sort of poke their heads out and they may floor a little bit, but stay close to go back to the den overnight before it gets too cold. And then as it sort of starts to heat up on average throughout the late spring, summer and early fall, they sort of spread out.

And look around and try to capture prey. And then as it starts to get cold again, they start to make their way closer and closer to the den site and sort of hang around that area. So that’s, it’s common for people. You see these videos on social media and other places of like lots of rattlesnakes in one den site.

That’s an area where a den exists. And so they’re sort of coming out, but they’re not ready to [00:15:00] spread out. And then sort of the time of day that they like to come out. It really depends on, again, the, where the heat is for the day because they can’t be very active when it’s really cold. And what that degree is depends on the species of the rattlesnake and how they are acclimated to their given area.

But the colder it is, the less they want to sort of move around. And so maybe during the early spring or late fall, they might be more out in the daytime trying to be in the sun and get warmer. But they don’t like to be in the direct light because there’s predators out, there’s hawks and other things that may swoop on them.

And so really their most active time is typically they would prefer sort of dust, dusk, and dawn. And they even in the summertime, especially in much hotter areas Arizona and Southern California, Texas. If it’s really hot out during the evening or the mid-morning, they don’t wanna be out.

If you think it’s [00:16:00] too hot for you, it’s probably too hot for them as well. And so they really wanna be out like seventies to low eighties. Everybody thinks like, oh, it’s 105, all the snakes are out. They don’t wanna be in that temperature. And so they may be out midnight, late evening type of area.

It’s much, much more cooler and more comfortable for them. And so it just really varies based on the timing of the time of the year. And what’s around,

Linda : So when I’m looking at a snake, how do I really know that it’s a rattlesnake?

Nick2: So identifying a rattlesnake there’s all sorts of ways to do it. There’s also all sorts of misconceptions. The easiest way to tell if it’s a rattlesnake is they have a rattle. There’s no other snake in the region that has a rattle on them. Now, with that being said, There are many snakes that are non venoms, like bull snakes which are subspecies of gopher snakes and other sort snakes that look like around a snake.

They’re brown. They’re long, they can be pretty feisty. They actually [00:17:00] rattle their tail as well against the ground as a defensive threat mechanism. And so they often get confused her rattlesnake. Um, A lot of people think about sort of the slip pupils versus round pupils. So it’s a slip pupil.

It’s a rattlesnake. That’s kinda true except in dark scenarios. They rattle sinks can have quite round pupils. And then the other way is sort of the diamond head versus the non flared out head. But again, it could be difficult with like hog no sinks, for example, that really like to flatten their heads when they’re threatened and they kind look like a pit viper.

And so really if, if you’re ever. Bit by a snake and you just cannot identify it. I would use caution and get, and at least seek care, cuz I’d rather be near or at a hospital or on my way to a hospital if symptoms develop rather than waiting it out and being in the middle of nowhere uh, [00:18:00] meaning to be emergently evacuated.

So they can be, they, it can be a little difficult, especially if you get bitten by a snake, right? You’re riding your bike, all of a sudden you’re bitten by a snake. Your adrenaline is going. We don’t often make the best decisions in those scenarios. And so being able to laser focus and know exactly what snake you’re bitten on can be, I wouldn’t trust trust judgment in that scenario.

Linda : Right. Right. No, that sounds like really good advice. So to recap, it sounds like what you’re saying, If I get bit by a snake, I don’t know what it is, assume that it’s, assume the worst and start taking some action heading toward a hospital so that in case that I do start to swell up or have some of the other symptoms that I at least I’m near a hospital.

So tell me about recovery. So if I’ve gotten bit by a snake, how long does it, and, you know, and I get the venom, how long does it take to recover from.

Nick2: It can be quite a, it can be quite a long time for recovery, so we don’t know the exact numbers we need to do better [00:19:00] studies on this. But it’s postulated that approximately 25% of those bitten have, will have long term consequences from the snake bites that’ll never go. . Most people sort of have some pain or some swelling for a few days and they get better and they develop full function of whatever limb was bitten within the next couple weeks.

But some people have ongoing swelling that’s recurrent. They have ongoing neuropathic pain or they sort of have nerve injury that causes an ongoing pain. And so, It can vary depending on how your bite is and how it was managed.

Linda : Right. So let’s talk a little bit about. Mention. I know in Oregon in the spring, we’ve seen a lot of snakes. I don’t recall seeing too many rattlesnakes, but occasionally we’ll run across a rattlesnake in Eastern Oregon. So do things like wearing long socks help I, if I know it’s rattlesnake season, is that a good idea or do they need to be really thick, long?

Nick2: The long socks may [00:20:00] help you. We definitely know that wearing long pants will help you. Wearing appropriate footwear will help you even if you, even if the thing punctures like your jeans or long pants, for example. There’s actually a de decreased. Amount of venom that gets injected on average.

Thin biking socks or just thin sort of running socks, not likely to be of huge benefit if you have a strike occur.

Linda : Right, right. . Okay. Is there anything that I should be carrying with me in a first aid kit that would be helpful? In the. Of being bit by a rattlesnake

Nick2: Your cell phone and instead of car keys is really the only thing that’s gonna be to benefit. There’s no real first aid other than isolating the extremity. So maybe a sling or a cr a wrap that you can sort of put the, put your arm up or to not use it, but otherwise, As we talked about, the suction devices don’t work.

Cutting yourself shouldn’t work. [00:21:00] Medications don’t work. There’s not really much else that is gonna be a huge benefit. A lot of people also think carrying what’s called a crepe wrap or like a lymphatic wrap that is often used in Australian snake bites. May be helpful. It’s not helpful. It may likely be harmful as.

Linda : Okay. Interesting. And is there anything else I should be doing differently? I know when we have a group ride, I, if it’s snakes, snake time, I always tell people, okay, like if you’re gonna, if we’re on a road, it’s easy to see a snake, but if you’re gonna go pee in the woods, make sure you’re looking around as to where you’re walking.

Is there any other words of wisdom that you would have for us as cyclists?

Nick2: Yeah, I mean, so snakes tend to like to coil up on the side of trails, not in the center of trails. Cuz they’re ambush predators. And so being more aware of your surroundings when you’re near the edge of a trail is important. And certainly stepping where you can see. Not putting [00:22:00] your hands in areas where you can’t see, et cetera, would sort of hopefully minimize any contacts you have with a snake.

Rattlesnakes, they’re camouflage predator. And they also try to use their camouflage to avoid predators. And so you’re, you were a predator to them. . And so they often don’t rattle. Some of ’em will, but there’s a lot of snakes that have been near you that you have never seen.

I don’t wanna freak anybody out, but that’s just the way it’s um, because the snakes try to stay still they’re very well camouflaged. The rattle part comes when they feel that their camouflage has been compromised and a bite occurs when they feel like you are too close and it’s time to act.

Linda : S So if a rattlesnake is coiled up, how far can it strike? How far away should I make sure that I’m standing?

Nick2: Half their body length.

Linda : Half their, oh, half. Half their body linked.

Nick2: yeah, so in Oregon you guys have Northern Pacific [00:23:00] rattlesnakes. Those are maybe average the average adult is maybe three foot. If you got a four foot north Northern Pacific rattlesnake, that’s a big rattlesnake there. And so you’re talking, a foot and a half on average for an adult to strike which isn’t, it’s a lot That’s pretty close.

Most people are surprised. They think they, these things can jump and do other things. They can’t really go that far.

Linda : Yeah. That’s interesting. Yeah. I would’ve thought they could go a lot further and will a snake bite if it’s not quailed up? Or is it, does it need to be quailed up in order for it to really strike you A rattlesnake?

Nick2: The, the coil is the best defensive position for them. But for example, if you were walking and this snake was stretched out, crossing the path for example, and you didn’t see it don it, it would turn and just bite you. It wouldn’t need to sort of coil up before doing that.

Linda : So coiling is just sort of, its way of communicating to me like, Hey I’m warning [00:24:00] you, you need to leave. Where if I’m really close to, it’ll still bite me. Is that what I hear you saying?

Nick2: Well, a coil, the coil position is sort of the camouflage position, so they often rest in that position. The coil is also a nice defensive posture, but they really wanna get away from you. And so if you allow them that space to get away from you, they will sort of move in an uncoiled way, but still a defensive posturing where they, you sort of see the s shape in their neck and trying to get away from you.

But they don’t, they do not wanna interact with you. You’re much bigger. They’re very scared of what you may potentially do to them. So if you give that space, they may uncoil.

Linda : So I have a question. A lot of times people think the bigger the snake, the more venom has in it. Is that true or false?

Nick2: That’s true. I think a lot of people have this misconception that baby rattlesnakes are more dangerous than bigger [00:25:00] rattlesnakes cuz they think that they can’t control their venom, which is not true. So they can control their venom just as well as adults do. Certainly a larger snake, if you think about how much bem they have.

It’s about the two peanut size m and mss worth of venom versus a baby rattlesnake, which is two tic-tac size amount of venom. And so certainly if I were to have the choice, I would not want to be bitten by the adult snake just to do to them having so much more venom than the baby rattle sneaks.

More Info

Linda : So Nick, tell me about how we can learn more about rattlesnakes and other snake bite issues.

Yeah, so, you guys can go to www.snakebitefoundation.org. That is the Sleepies Snake Bite Foundation that I work with. Now that organization does focus more on exotic bites, snake Bites in Africa, India. But we do some local consulting as well. And we’ll answer your questions. There’s other great [00:26:00] organizations such as Save the Snakes uh, the Rattlesnake Conservancy and Adaptation Environmental Services that do rattlesnake education and our good source of information for people to get their questions answered.

Closure

Linda : Okay, perfect. Awesome.

Yeah, this is great. I’m really excited. We got so many questions from people about rattlesnakes. Cuz most people, if you do a lot of riding in Arizona, they’ve run, you know,

they’ve run across a rattlesnake so they’re all, everybody’s all terrified of getting bit by one, including me. So, this is really great information.

I appreciate you taking the time to meet.

Yeah, no problem. I, if there’s any other follow up questions or you guys have more stuff, just let me know.