June 21, 2012
BehindTheMedspeak: Snakebite — Everything you were taught is (dead) wrong
That goes for me as well, though it's only dimly — if at all — that I remember the subject from 2nd year med school pharmacology and various rotations on the medicine wards.
Caption for the photo by Sabrina Schaeffer (above), which accompanied the Progress story: "Dave Maurer's left arm on May 14, two days after the snakebite, still shows significant swelling. Emergency medical personnel made a series of marks on his arm to track the progress of the swelling."
Don't be confused as I was by Maurer's right arm being closer to the camera.
Encounter with a Copperhead
I recently had the good fortune to be bitten by a copperhead snake.
Of course, I wasn't seeing it that way as I lay in Martha Jefferson Hospital with CroFab antivenin coursing through my veins and my left arm swelling to Popeye-esque proportions.
It was only after the considerable pain, bruising and swelling had subsided that I started to have a more enlightened take on my experience with envenomation. My awakening came as I learned fascinating facts about the poisonous snakes indigenous to Virginia — copperhead, cottonmouth and timber rattlers — and the blessings of modern medicine.
My encounter with the copperhead occurred around 9 a.m. May 12. That Saturday morning, I was topping a stand of bamboo that grows under the power lines leading to my Albemarle County home.
I was using short-handled clippers and had reached into a clump of bamboo to lop off a long shoot. I felt an unusual pain on the inside of my left wrist that made me think I had stabbed myself on a sharp piece of bamboo.
My second thought was that I had somehow gotten a cramp in my wrist. I quickly changed that assessment when I saw the two small puncture marks just above my work gloves.
In one of those remarkable displays of the brain's recall ability, I immediately pictured the U.S. Army Special Forces instructor who had given my class a lesson on poisonous snakes during my training in the mid-1960s. His first remark on what to do if bitten: "Don't panic. You're probably not going to die, but get medical attention as soon as possible."
I took him at his word. Being dirty and sweaty, I showered, changed clothes and made sure my dog had plenty of food and water.
All this took about 10 minutes, and in that time the swelling above the red bite marks had become noticeable. The pain was also increasing, but nothing I would term excruciating.
I called my primary physician, Dr. John Lanham, who told me to come right in. He has had experience with snakebites from his time practicing medicine in a remote area of Sudan. It took him about 10 seconds to assess the situation and send me off to MJH’s emergency room.
"The nature of the venom is hemorrhagic, and that's why you had the bruising," Lanham said. "Some of the venom ruptures red blood cells and some of it lets the blood leak out, which causes the swelling.
"Then there's also certain types of enzymes that cause local tissue necrosis. It was primarily the pain you were experiencing and the local swelling that had already occurred that got you out of here and to the emergency room pretty fast.
"It looked like there was more going on than just the pain from the strike."
Aside from the pain, which had escalated to a burning sensation along the length of my left arm, I felt fine. I had no problem driving the few miles to the hospital.
At this juncture, I already had learned two valuable lessons.
The first: During warm weather, never put your hands or feet into grass or bushes where you can't see where they're going.
Secondly, never assume the snake is going to be on the ground. The copperhead that bit me was at least 5 feet up in the bamboo.
I never saw the snake, but it had to have been small in order for the bamboo to support it.
Victoria Brianna Hovey was bitten twice by a young copperhead on May 22. It was the day before her 12th birthday, and she was visiting her sister in Stanardsville.
"I was in the driveway getting ready to get in the car when I startled the snake, and it bit me," Victoria said recently as she recovered in her Greene County home. "I screamed, and when I jumped back, I stepped on its tail and it bit me again [on the other leg].
"It felt weird, like a pinch. My sister's boyfriend tore his shirt in two and tied it around my ankles so the poison wouldn't go up my leg, and then he called [emergency].
"They told him to take the shirt off [the ankles] and get me to the hospital."
Dr. Christopher P. Holstege, director of the Blue Ridge Poison Center at the University of Virginia, said applying a tourniquet is an absolute no-no. So are other widely believed practices.
"There's so much misinformation about first aid for snakebites, even from somewhat reliable sources," Holstege said. "I’ve seen probably more harm done by cutting and tourniquets than from the snakes themselves.
"Before we had good studies on this, people would do some very crazy things. They would put tourniquets on with the thought it would keep the venom in one place, but this does more damage than good.
"People would cut open the site of the bite and try to suck out the venom. We know suction doesn't work at all, and, in fact, studies have shown it does more harm.
"Many of the snakebites we see are on the feet and hands. If you cut in those areas, there's a good chance you'll cut tendons, nerves or other structures."
Cutting the proverbial "X" at the site of the bite only creates a more serious wound and greatly inhibits healing. And not only is it impossible to suck the venom out, but the attempt can deliver bacteria from the mouth into the wound or venom into the mouth.
"The venom goes into the subcutaneous tissues, so you're not going to get it out by sucking; you're just not," Holstege said. "There's a number of snakebite kits on the market, and I'm absolutely appalled they're allowed to sell them.
"In the kits are a suction device, scalpel and a shoestring you can use for a tourniquet. All the things we know that cause harm and don't work.
"We now know that even applying ice to the swelling does more harm then good. You think because there's swelling, ice would be a benefit, but studies show that's not the case."
Mendoza said another danger of a snakebite kit is that it gives a false sense of security to the user.
"You think your snakebite has been treated and it hasn't," Mendoza said. "The best snakebite kits are car keys and the nearest hospital."
Below, a sidebar that accompanied Maurer's story.
An aside: Maurer is, in my opinion, the best writer on the Daily Progress staff, good enough to fit right in on the New York Times, Washington Post, Wall Street Journal, or any English-language publication in the world.
Why he's stayed with my Podunk town's paper for decades is a mystery to me.
Full disclosure: Maurer came to my house in January, 1993 to interview me for a story on my first book, "Baby."
The article appeared in the Daily Progress on February 25, 1993.
62-in-1 Universal Card Reader — One device to read them all
Lord of the media cards.
"This USB 2.0 SIM card reader can access nearly every type of media card ever made."
Aren't you just a little bit curious about what might be on that collection you've accumulated in your desk drawer over the years?
Stare at the red dot — then see the woman in full color on a wall
Wrote Steve M on Radio Vice Online, "I have no idea how to describe this, let alone create an understandable headline for this story. Just follow the instructions."
1. Stare at the red dot on the woman's nose for 30 seconds.
2. Turn your eyes towards a wall.
3. As soon as you move your head, start blinking your eyes quickly.
[via Virginia Moore]
Crocodile Head Bathtub Plug
[via Paul Biba]
Dys app increases reading speed in dyslexics by altering letter spacing
Talk about applied science.
Wrote Robert Lee Hotz in a June 4 Wall Street Journal story, "Children with dyslexia can read faster and more accurately when letters in text are more widely spaced, showing an immediate improvement equal to a year's worth of classroom instruction, Italian and French scientists reported."
More excerpts from the article follow.
In a series of experiments, children diagnosed with the common reading disorder could read 20% faster and twice as accurately when reading text with extra-large letter spacing, the researchers reported in a study in the Proceedings of the National Academy of Sciences.
"We found that when reading the widely-spaced text the number of errors was about half," cognitive scientist Marco Zorzi at the University of Padua, who led the research group, [said]. "The increase in speed was notable. It corresponds to the increase you would see after one year of schooling."
Their finding highlighted the scientific importance of typography in easing dyslexia. It could have immediate practical applications because it is so easy to alter the characteristics of text, such as type size, font, and spacing in computer word-processing software and in electronic books, the researchers said.
Everyone is susceptible to the differences in spacing between letters. Reading speed in skilled readers is usually slowed down when letter spacing is doubled, and most typography design takes that into account.
For dyslexic children, however, the standard spacing that works so well for skilled readers may seem crowded, causing them to take longer to translate the letters into sounds and to make more mistakes deciphering them because the typographical features of characters blend together.
"When you increase the letter spacing, the reading improves on the fly," says Padua neuropsychologist Andrea Facoetti. The increase in reading speed worked out to about one-third of a syllable per second.
Moreover, the simple change in the visual appearance of text improved reading among dyslexic children whether the text was in French or in Italian, suggesting it may hold true for any language that uses the alphabet.
While the two languages use the same letters, they treat spelling differently. In French, one letter can represent different sounds depending on its context and the word in which it appears, in much the same way as in English. In Italian, each letter always stands for the same sound.
The interactive application allows people to tinker with the spacing between letters to find the one that most enhances their reading performance, compared to standard spacing.
The app is free, the way we like it.
Shaka iPhone Wind Meter
You don't need a meter to know which way the wind blows.
Wait a sec... what's that music I'm hearing?
But I digress.
Question: Is there a women's version in the works?
Ah, Ronda (Spain)
Commented reader Fred on Sunday's post about this town, "Ah, Ronda. I'd like to retire there. Not too big a town, and not too small, and with enough tourist interest to support good restaurants, bars and shopping. The height and cliffs make me feel so alive there. See the building on the left? That's the Parador. Great place to stay. Particularly if, like us, you book the rooms at the top right with their own large private terraces overlooking the incredible views: http://en.wikipedia.org/wiki/File:Bridgeronda.jpg."
Worth a trip, seems to me, and mos def a stop on my long-paradoried [sic] but not yet DBI (defunct before initiation — my latest acronym coinage) world tour.
Ultimate Claw Hammer — Richard Remsen
Richard Remsen's creation is the last word on the subject until the end of time.
And you can quote me.