This weeks interesting/problem case - snake bite??

Re: this weeks intersting/problem case - snake bite??

Simon Neuhoff — Tue, 13 Apr 2010 12:44:27 GMT

My wife had a suspected adder bite last week (Surrey) so yes think its the season!

Re: this weeks intersting/problem case - snake bite??

Nixthevet — Mon, 12 Apr 2010 14:16:20 GMT

Hi there,

I believe that one of our clinics treated an adder bite last weekend- so it sounds like they are out and about already.

Re: this weeks intersting/problem case - snake bite??

Bob Russell — Thu, 01 Apr 2010 13:29:12 GMT

We are based in the New Forest so see adder strikes quite regularly. It is quite clear to us that the strikes early in the season are much more worrying than later on. Presumably a hungry adder is more aggressive. We do see strikes occasionally in the winter, usually on sunny but not necessarily warm days.

Some dogs come in with quite typical strike marks but little or no signs of venom being 'injected' - they still yell so presumably these defensive strikes are to warn rather than waste venom.

Re: this weeks intersting/problem case - snake bite??

Vikki Moran — Sun, 21 Feb 2010 21:07:15 GMT

[quote user="Mary Thomson"]Vikki, don't you find you spend loads of time mulling these cases over?[/quote]

yep! Glad i'm not the only one then!

funnily enough i saw the owner of this dog today, to fill in the paperwork for his export of another dog to the US. He commented on having had pets suffer from snakebites in the northern US even during winter, so he didn't think it was that unusual.

Re: this weeks intersting/problem case - snake bite??

Mary Thomson — Sat, 20 Feb 2010 21:48:31 GMT

Vikki, don't you find you spend loads of time mulling these cases over? Sounds as if you did absolutely everything you could but it's always really tough in such a young animal. I used to work in Cornwall and we used to see adder bites all year round. Obviously not so many in the winter, but I'm sure there were occasional cases at this time of year. Like Richard, we used to use IV dexamethasone, antibiotics and IVFT. This was the protocol of the practice. I am from Scotland and with little experience of such cases I figured I should stick with the protocol that had been working for the practice for decades!

I was lucky never to have a case as bad as the one you discussed.

I now work in a practice which keeps antivenom in stock and have not seen a case since I've been here!!

Re: this weeks intersting/problem case - snake bite??

Richard Carter — Wed, 10 Feb 2010 11:27:30 GMT

Cortisone contra-indicated? The pathology of an adder bite is of extreme inflammation leading to hypoxic destruction of tissue (and with DIC as a potential complicating factor). I certainly do give large dose dexamethasone i/v with very good results without any apparent spread of septicaemia - my last case was a small terrier who didn't stop trying to kill the adder that was fighting back, came in blue, tongue the size of her whole muzzle with very good recovery. Stop blaming steroids!! Would be more concerned of NSAIDs in a potentially hypotensive situation

Re: this weeks intersting/problem case - snake bite??

Vikki Moran — Fri, 05 Feb 2010 22:53:26 GMT

thanks everyone!

i was actually more interested though to know if anyone has had one at this time of year?

Re: this weeks intersting/problem case - snake bite??

nikki — Wed, 03 Feb 2010 20:59:28 GMT

we get loads of adder bites down here in Surrey. my own dog got bitten the week after we got him. we have a standard practice protocol for treating them and a fridge full of anti-venom. They all get IVFT, antivenom, broad spectrum antibiotics, antihistamines and only get anti-inflams if the above isn't working, but generally not needed. everyone is always on high alert for any suspcious sounding history, sudden onset lameness, leg/facial swellings. the only one i've seen end up a mess was at a previous practice with no antivenom and the skin on one whole leg sloughed off and the leg needed amputation. i've been at this practice over 2yrs and we haven't lost one to an adder bite yet.

my own dog got bitten under the throat, had a night on IVFT, antivenom, antibiotics and anti-histamines, discharged the following day but after a few days we started nsaids as the massive tissue swelling was restricting his breathing - that worked well and he was back to normal within about 10days.

Re: this weeks intersting/problem case - snake bite??

Vikki Moran — Thu, 28 Jan 2010 12:47:27 GMT

good to hear he's doing well.

sadly for us, if there were a confimed snake bite we don't even have a vets now within close reach! as far as i am aware nobody locally stores antivenom besides the hospital. though i might have a ring round just to establish that!

Re: this weeks intersting/problem case - snake bite??

katja wagner — Wed, 27 Jan 2010 20:04:13 GMT

thanks for your replys!

he was back this morning and to my relieve much better, already putting some weight on the leg. swelling and bruising improved a lot,no more oozing, his appetite is back to normal and he was a much happier chap then yesterday. still no other clinical abnorm. and no bite marks to find so i have send him home with oral antibiotics and more rimadyl. will check him again in a few days and owner has strict order to monitor him closely.

i have treated a few snake bites succesfully in the past and given all of them antivenom iv in slow running drip, usally like to give antihistamine and combi of antibiotics, i try to withold steroids but have used it with great success in a dalmation with a head the size of a football where i was just too scared to watch his breathing efforts any longer and the steroids,iv ,real did the trick.

we always store some antivenom as adders are rather common in our area and we got a special liecence last year when we were unable to get any . its always worth asking vets now if they can help you out a colleague of mine did get some of them last year.

thanks again

regards katja

Re: this weeks intersting/problem case - snake bite??

Toby Birch — Wed, 27 Jan 2010 16:08:49 GMT

Hi Katja,

Hope the dog is improving. Corticosteroids are actually contraindicated in the treatment of snakebite as they may exacerbate scepticaemia. I refer you to http://www.vetsurgeon.org/forums/t/2994.aspx for some information on how to potentially treat these cases.

Antivenom 3 days later (if you have it in the fridge or can get it quickly - otherwise you will have to wait for your wholesaler to deliver and then retrospectively complete a STA form) is unlikely to be of any use. The VPIS report that only 5% of dogs that do not receive antivenom die but obviously this may be age/size related as well. A few days down the line then main problems may actually be caused by the SIRS/sepis and related, possibly sub-clinical, DIC rather than from the actual venom. It may be that correct antibiosis, wound management and potentially fresh frozen plasma depending on coagulation status is your best bet. Hopefully it won't come to that.

Cheers

Toby

Re: this weeks intersting/problem case - snake bite??

Vikki Moran — Wed, 27 Jan 2010 12:20:33 GMT

I think the only reason I could see the wound in my case was because of the massive cellulitis. the wound itself (themselves?) was pripping blood, but the rest of the leg had pinpoints which were oozing serous fluid. I know that my colleagues felt they had checked thoroughly for any wounds and not found anything, so I would hope it wasn't that they missed it, rather that the wound wasn't apparent.

I don't know if antivenom is worth using so long after a possible bite. I did give steroids after nsaids, but on the basis that i was using injectible steroids, the dog had only had injectible nsaids, and it was already on it's way out, and it seemed either kill or cure, so to speak.

how was he today?

Re: this weeks intersting/problem case - snake bite??

katja wagner — Tue, 26 Jan 2010 22:16:06 GMT

I have seen a young border collie today who was on a long walk last sunday running around free and possible out of owners sight. owner did not notice anything unusual during or after the walk,dog was still fine sunday evening,eating well and no limb. monday morning owner noticed that he seemed to limb at right hind leg and gave him dose of rimadyl tablets he still had left from a previous event. during monday the dog was a bit more quiet then usual and the limb became worse,no other problems noticed,owner repeated rimadyl monday evening and tuesday morning then decieded to see vet (me) as suddenly not using the leg at all. so i have seen him today ,he is on 3 legs and there is rather bad swelling around lower metatarsus and 2 toes,white fur,no blood visible ,clipped the hair off in this area and found extended bruising like on above pictures, i could not find a wound or any marks at skin at all but under slight pressure there was a small amount of watery bloods/puss oozing from skin, temp. 38.5C might have been higher without the rimadyl he had, all vital parameters where normal, i would have like to sedate him to investigate further but he had some food before owner came so was not eager to do this, gave baytril and synulox injections and will see him tomorrow morning again starved. i did think about snake bite but was unsure due weather condition/not right time of the year, no report of crying or acute lamness and because i was unable to detect a wound but might be that its so small that i missed it? i am a bit worried now after reading above report which i found very interesting,cant real use steroids anymore as owner already gave rimadyl for 2 days, i plan that if there is no remarkable improve tomorrow to admit him for bloods,iv fluids then if no abnro. on blood test will ga him and x ray first then possible open to check for fb . would anit venom still make sense after 3 days ?

regards katja

Re: this weeks intersting/problem case - snake bite??

James Allsop — Tue, 26 Jan 2010 18:07:35 GMT

I saw a young spaniel about 3 months ago - he presented to one of my colleagues on the Saturday with a swollen foot after a walk. no wound was found on exam so he was given metacam and Amoxy-clav and went to kennels the following day as the owners were on holiday that week. I saw him monday when the kennels said he was worse - they wern't kidding!!! the skin and flesh between digits 2&3 had sloughed leaving a 5-6cm deficit down to bone. There appeared to be no haemorrhage or inflammation. within the next 24hrs P3 and nail from digit 3 fell off also. I treated it as an open wound as the rest of the dog was fine. after 3-4 weeks of regular dressing changes and moist wound healing dressings he healed up well enough to carry out a small surgery to close the remaining deficit. I can only put this down to an adder bite to cause such rapid tissue necrosis etc

Re: this weeks intersting/problem case - snake bite??

Vikki Moran — Tue, 26 Jan 2010 17:47:31 GMT

well, i have been looking into adder behaviour, and the herpetologists say that adders hibernate when the temperature is below 9 degrees, and I know that we have had daytime temperatures nearing that during the last week. certainly at the start of last week i noticed it was about 8 degrees anyway! so cue one nosy young retriever, walking in an area where adders have been sighted, and possibly one not quite awake but really pissed off adder....

Re: this weeks intersting/problem case - snake bite??

Vikki Moran — Tue, 26 Jan 2010 17:16:33 GMT

move that wound down to the caudal aspect of the carpus and that's what i was looking at on sunday, though a bit more swollen and with cutaneous leakage!

Re: this weeks intersting/problem case - snake bite??

Toby Birch — Tue, 26 Jan 2010 17:08:47 GMT

Hi Vikki,

I wouldn't rule out a snake bite. Post hibernation (and end of season) bites are worse and a bite in that location may also be worse than another location.

Some discussion on anti-venom and treatment of snake-bites can be found on this site at http://www.vetsurgeon.org/forums/t/2994.aspx

and I posted some photos of a neck bite so they will be in the gallery.

I had a suspected snake-bite (or a.n. penetrating injury) in a golden retreiver last year. Despite everything I eventually lost it to a pericardial effusion - I put this down to a side effect of the (confirmed) dic/sirs. Very frustrating. This is what the limb looked like at presentation...

Re: this weeks intersting/problem case - snake bite??

Vikki Moran — Tue, 26 Jan 2010 16:23:25 GMT

yes that would be interesting,

It did cross my mind but i would have thought with the mass antibiosis kill or cure approach from my colleague I wouldn't have seen such a downwards progression so rapidly?

Re: this weeks intersting/problem case - snake bite??

sam aldridge — Mon, 25 Jan 2010 14:23:47 GMT

they can get it - one of the vets I used to work with saw a case as a referral at the RVC - progressed very quickly and had to be PTS but I dont know what tx it was given - could probably find out though if anyone is interested

Re: this weeks intersting/problem case - snake bite??

Utlendigur — Mon, 25 Jan 2010 13:43:41 GMT

Just wondering...do dogs get Necrotising fasciitis? That could give the same massive cellulitis, sepsis, shock etc from a small wound (eg http://www.guardian.co.uk/uk/2005/may/24/military.health)

http://en.wikipedia.org/wiki/Necrotizing_fasciitis

Re: this weeks intersting/problem case - snake bite??

Vikki Moran — Mon, 25 Jan 2010 09:06:29 GMT

no i didn't get clotting times for him. i was quite limited on time yesterday, as the practice i work in runs a normal work day on a sunday so i had appointments 9-11.30 and 1.30-5 but only one vet working, so i did what i could in between times. I had another shocker of a day actually, seems the sundays are either exceedingly dull (vaccinations and post op checkups) or really really interesting cases like this one.

It did really get to me though, i was quite upset having to pts him, partly as he was so young, partly that the owner was so far away, partly because i didn't feel entirely convinced that i knew what was wrong and therefore if there was anything more i could have tried.

As for antivenom, we don't stock it, as snake bites are so rare, and i know that the nearest hospitals to us don't either, as i recall a case a few years ago when a colleague found it almost impossible to get hold of. the nearest human hospital that had some was almost 2 hours drive and they refused to let us have any.

my boss said "there's not a snake alive that would be active in this weather" but i don't agree, i think it's been no colder in the last week or two than it would be in October, and snake bites are certainly not unheard of then.

i just don't know what else it could be. we don't have venomous spiders, and what else would cause sch a dramatic cellulitis, haemorrhage and rapid death like that? i would have thought ingested poison wouldn't cause a localised cellulitis. and if it were merely a pucture wound causing cellulitis and a bacteraemia, he would be pyrexic, and the rapid progression of renal failure wouldn't be a feature?

I should stop thinking about these things so much. get more sleep!

Re: this weeks intersting/problem case - snake bite??

Lucie Allcutt — Sun, 24 Jan 2010 21:59:20 GMT

In my time as a student so far here at the University of Florida I have seen a few cases of snake evenomation (Florida has no less than 7 species of venomous snakes!) and I agree that your case sounds very suspicious for a snake bite (localized swelling, cellulitis and subQ hemorrhage with puncture wounds identified, shock). Did you by any chance get any clotting times on him?

Four out of the five cases I've seen have gone into DIC and not made it in the end (some even with the benefit of antivenin!).

Some googling of european adders says this: "On mild winter days, they may emerge to bask where the snow has melted and will often travel across snow."

In my limited experience, it sounds like you did what you could for him :-(