Tuesday, July 19, 2011

Snake in the grass!


Image from here

A few days ago, hopping out of the car and striding ahead to the house in front of Mum, I notice a black and yellow shoelace lying on the path. I stooped to pick it up and realised that

a) No one at home wears lace up shoes anymore
b) Shoelaces don't taper off towards one end

I shrieked and jumped back as my brain processed the triangular head with the wicked eyes and the familiar mottled markings of a baby Russel's viper, and my muscles worked on a survival instinct of their own. The fellow was tiny, compared to the monster in the picture above, actually looked more like this.

Panic and pandemonium reigned for a few moments and with the help of the neighbours, the offending critter was hacked to pieces... I didn't watch (too busy with a mini trembling fit inside my room), and although I am all for the sanctity of life and live and let live mindset, I was not in the mood to suggest catching it and sending it to the snake lab of the Colombo Medical Faculty (where the snake venom is milked for experiments).

Daboia russelli is one of the deadliest snakes in Sri Lanka... the venom wreaks havoc on a number of body systems, messes up the clotting, poisons the liver and kidneys, causes dangerous heart rhythms and can damage the nervous system, i.e. you're pretty much screwed. Antivenom is available, but it's a polyvalent antivenom (common remedy for several types of snake bites) that's is imported from India. Although quite effective, it causes unpleasant allergic reactions - fever, chills, rashes, itching, clogged throat, and in about 40%, anaphylaxis, which is life threatening. In fact, a patient once said to me "Doctor, I died and went to hell twice and crawled back. Once when the snake bit me, and once when you gave me the injection".

Dr. Asitha de Silva and his team recently published an article in PLoS Medicine, which will revolutionize how snakebite is treated in SL as their method can reduce adverse reactions by over 40%. Hurrah for the doctors who are doing something to take snakebites out of the "neglected disease" category!

According to the Annual Health Bulletin, 39,321 patients have been admitted in the year 2007 to Government hospitals following snakebite. Most are probably from non venomous snakes, but that's one of the biggest problems we face - difficulty in identifying as the snake is often not brought. Of course when they DO bring the snake, that can result in complications as well. I have my share of snaky stories... just like most of the other docs out there...

Once the patient was accompanied by a 3 foot long live cobra in a gunny sack, which was jumping around like crazy and obviously enraged. The relatives kept egging me to peer inside the sack and confirm the identity and I kept saying no effing way. Finally, they killed the fellow and put it in a glass jar and brought it back to the ward... gah!

On another day when I asked "did you see the snake?" the patient signaled to his friend, who promptly dropped the snake at my feet. I screamed and leaped on to my chair before you could say "fatal haematotoxicity"... and then realized that the snake was, thankfully, dead. That is of course no excuse and I swear that incident is responsible for my crop of grey hairs.

Yet another day a couple of teenage rasthi-types walk in holding a jar that had a coiled up krait. Apparently one of them had felt "something" and then noticed the snake. I was quite pleased since we had a suspect, and careful examination (I went over his skin with a magnifying glass) showed that the guy hadn't been bitten after all. I asked him to stay for 4 hours observation just in case (as he said he felt something), but next thing I know, they had disappeared, leaving the snake filled jar on the floor of the corridor, where to my horror, it was kicked by an unwary labourer and went rolling around the ward! Much frantic scrambling later, the snake (still in the jar) and I were eyeballing each other from opposite ends of the doctor's table. It took another 4 hours to find a labourer who was willing (read - not too scared) to hand the snake over to the Faculty.

So what do you do if, gods forbid, you or someone with you is bitten by a snake?
  1. do not panic and run around (muscle activity = the venom will be absorbed faster)
  2. remember that most snakebites turn out to be harmless
  3. do not cut or suck at the wound, don't apply ice
  4. wash with soap (if available) and clean water
  5. remove anything that might constrict a swelling limb : bangles, rings, watches etc.
  6. immobilise the limb, if possible at a level below the heart. If it's a leg, splint/tie it to the other leg, or use anything handy (e.g. an umbrella) as a splint. The victim would need to be carried, which is all the better since that minimises muscle activity.
  7. don't tie tourniquets (reduces blood flow to the whole limb and may make things worse)
  8. don't give aspirin or ibuprofen; paracetamol may be given if pain is severe
  9. take the victim to the nearest government hospital - most are equipped to deal with snakebite
  10. don't waste time searching for or killing the snake. Even dead snakes can give a "reflex bite" and you may become the second victim!
Stay safe, all!

Friday, July 15, 2011

Back...! And rushed off my feet*.....

So yes, back in sunny, warm, humid Sri Lanka, which is very similar to sunny, warm, humid Malaysia, except here I do not have the luxury of having air conditioned surroundings practically 24/7!

As you can imagine, being out of sight does not really translate to being out of mind, and I have come home to a *huge* pile of written (i.e. official) correspondence that needs to be followed up on and loads of other commitments, family, work, friends on my pending list.

To add to this, hours after I land, I learn my cousin has been diagnosed with typhoid, and also that my Mum has dense cataracts in both eyes, needing quick surgery. So, cousin was started on antibiotics, Mum goes in for surgery, and the next day Darling gets severe food poisoning and needs to be hospitalised. Thankfully, all are out of the hospital now but Mum will get her other eye operated next week and Darling is back on a "normal" diet and eating goodness knows what, so I'm feeling very gloomy when I think of the next few weeks.


*Needless to say, posts will probably be few and far between... and shoe post will be delayed until i have a pedicure... I cannot model ze pweety shooze while having ugly feets! :)