Folks:

Yesterday I spent the afternoon and evening in the hospital with an attack of kidney stones... I've been shot, I've broken my back, my hip and suffered various other injuries, but dad-gum... those suckers hurt so bad I threw up. The doctor would have shot me to put me out of my misery, I think, and I'd have welcomed it, but I held out for an English double rifle and he couldn't come up with one. After about three hours, I got some relief with a half gallon of hydrocodone. The attack has now abated and I go to the urogist in the morning to decide how to get rid of the wolf chewing on my guts.

I can't imagine being in the middle of nowhere, with maybe a two hour, bumpy-as-hell ride to an airstrip.. if it were daylight, if the satphone worked, if the weather was good... damn... then what hospital.. and who the hell is going to be sticking me with what?

This brings to mind several things:

1. Everyone who goes to Africa ought to have a supply of powerful pain-killers as prescribed by a physician who knows your medical history.

2. MedJet and other services are absolutely a necessary purchase.

3. I had a "minor" attack last week and was too damn lazy to go to a doctor to see what was going on. I could have avoided lots of pain and angst if I'd just listened to my body. Don't leave home with a "lingering" problem, be it a toothache, a bad cough or unexplained cramps or stomach distress.

4. You might well check on the first-aid training and experience of your PH and the company for whom he works. I believe that several countries require their PH's to take courses for medical emergencies. Such training will, for me, be a big plus in choosing with whom I hunt in the future.

5. A 2x2 hunt with a doctor in camp sounds better and better to me, particularly if he/she brought along a M.A.S.H. unit!

6. If I was on the first day of a 21 day safari, I'd have lost all my money... trip cancellation/interuption insurance is no longer an option for me.

Anyone else have any thoughts or experiences with suggestions above? I'm just glad it happened 5 miles from a well-equipped hospital here in the States.

Howdy Ernest, sorry to hear about your malady. You are spot on regarding any sort of "lingering" medical issues. When we went over there, I checked with the Navy Jag & medical and fortunately for us, all we have to do is check in with the embassy and it's on their dime should anything have happened. I'm off to Pensacola in a day or two and I'll check in once I'm established over there. Hope you are feeling better. jorge

Three words Flintstones chewable morphine! At least a weeks supply.

jorge is this true for any American citizen who is checked in/trip registered in the US Embasy or just for military service personnel? Thanks.

JudgeG, I know what you are talking about!! I have had kidney stones 3 different times. That is absolutely the worst pain I have ever felt!! Hope you got them taken care of.

I feel your pain. I had a kidney stone in 1992. First you're afraid you're going to die; then you're afraid you won't. Drugs are your friend. Of my female patients who have given birth and had a kidney stone, if given a choice, they will pick childbirth every time.

Judge
That is probably the worst pain one can have. I hope you are better soon. I just double checked the meds packed for Africa. We will be there this time next week.
Doyle

Judge I've had four kidney stones and I have felt your pain. I would think twice about taking enough opid pain meds to stop the pain and still have to navigate the bush on foot or vehicle. Check with your Doo about toradol injection if possible the pain relife can be equated to a small dose of morphine but, without the mental status change ( you wont get Hi).
Dr B

Judge,

Hope you are feeling better...Saw my Dad go thru that when I was a teenager...Doc sent him home in lala land with a shot of some powerful painkiller..

To all you vets I thank you...

Mike

Mike

I'm planning a trip with my wife and kids, I'm thinking about bringing a pretty big first aid kit. Has any one brought antivenom on a safari. Whats your opinion on doing so.

Does Medjet pick you in the bush with a helocopter, or do you have to get to a airport.
I don't guess that these African cuntries have a 911 service like the USA.
God Bless America!!
Dr B

Ernest, I sincerely hope you are feeling better. Take care of yourself, my friend.

Judge,

sorry to hear of your problems! - My partner Susan comes along on most of our trips where I'm the PH and she's a cardio thoracic theatre sister - with various other qualifications in tropical medicine etc which is very useful. We've never had a client get ill or injured, but it's nice to have her along just in case.

The downside of her coming along (or at least, for her) is that as soon as the staff see her, they all start lining up with their own minor and sometimes less minor complaints. She often bleats to me that while I'm hunting, her first couple of days are spent fixing up the camp staff...... the upside is that they think the world of her for doing it!

Dr B

Most safari companies have first aid kits of some sort - but they obviously vary in quality. We have one fairly comprehensive kit with each PH and a much larger one and a complete giving kit in each camp. Our PHs also get regular first aid (re) training. Antivenom doesn't keep very well in the tropics but there is a lot of research going on now with the electric shock treatments for snake bite. I know one guy who used to carry one of those self defence electric shockers in case of snake bite - but I don't think he ever used it. I believe the basics of it are pretty well proven though.

For anyone that doesn't know of this method. Snake bite is made up of chains of protein and electric shock beaks up those chains. You zap the patient with an electric current from a self defence zapper or even a HT lead from a petrol engine near the site of the wound and destroy the chains....... According to the reports I've read the patient is usually up and about fairly quickly.....I've never personally seen it done though.

The areas such as in RSA are never very far from a hospital - and many hospitals stock antivenoms etc - but as I said, it's not usual for the more remote hunting camps to stock them because of the problems with storage........ and of course someone knowledgeable enough to administer the correct doseage...... You'll know more about it than I do if you're a Doc, but I understand that children need a larger dose of some/many/most(?) antivenoms than adults due to the smaller body mass in relation to the same amount of venom......so correct doseage is very important......

Judge,
my suggestion is a little it different, take with you few or no pain-killers, and have a visit with a doctor, even if there are problems with the hunt.

I know a people that forget pain-killer during a hunting travel in Zim and for this reason is still alive.
Infact the pain made go to the doctor, who as saw him closed the rural clinic to bring him to the Bulawayo hospital, where he was operated for a peritonitis in act. The doctor after the operation said that she has operated an "almost dead man" and reserved the prognosis for two or three days, because she was not sure about his survive.

Forget my suggestion if there is a doctor at the camp of course.

IMHO if I survive I'll have time to recover the situation.

Steve,
interesting the zapping cure, but take info about pace makers, it can be dangerous for them

I don't know much about it other than what I've read - but if I'd just been bitten by a snake and saw some bugger coming towards me with one of those self defence zappers I think I'd be doing my best to run away...

You can always stop the bugger threatening him with the rifle. I think that it is better, if you run away you make poison work better and faster.
The threatening system allow you also to oblige the bugger in helping you in the way the you prefer

Shakari
Electricshock for envenonation is a folk remedy of the South Americain amazon. It was first noticed by a medical missionary, who brought it to attention to the developed world. One of the hunting Magazines wrote a article on it. One of the medical schools did some initial research on ES for envenomation and found that it was not reproducibale. This the last I heard of using ES. Maybe another Med school has taken on the reasearch but I haven't heard about it.

South African Vaccine Producers produces a polyvalent snake antivenom that covers the
Puff adder, Gaboon adder, Rinkhals, Green mamba, Jameson's mamba, Black mamba, Cape cobra, Forest cobra, Egyptian cobra and the black-necked Spitting cobra. They also produce monovalent antivalents for boomslang and saw-scaled viper.
I'm knot up on the distribution of snakes in Africa. Do you think that the polyvalent anivenom would cover the snakes you find in Zululand? The antivenom will last for three years if keep cool. it also might take as many as 20 vials to treat one patient.
If you are more that 30 min from a hospital and are envenomated by a Black mamba antivenom on hand might be your only chance.

For anyone who reads this in order to uses these antivenoms safely you need certian Medical skills, ability to start IV acces, and to treat anaphylaxis, which can be wore than the snake bite.

Dr B

We have a couple of medical doctors on tap who like to go on safari but who either do not hunt or hunt very little. When we get a clients in poor condition we send these guys along. The main thing is that the safari be scheduled long enough in advance so that the doctors can make arrangement to close their offices for the duration of the safari.

VBR,


Ted Gorsline

Doc,

Kayaker is the snake fundi - so I guess he'll be the best guy to advise you on KZN snakes.... but if you're in KZN, you'll probably not be a loooong way from a hospital. Do you know the name of the area you're going to?

Best practise is not to use anti venom. In certain cases people are alergic to the anti venom and it can be more dangerous than the venom. Most venom is transported in the limf system of the body. Wrapping the affected limb with a bandage will slow the movement of the venom. The patient must be kept flat and transported to a hospital as soon as possible. If it is possible., kil the snake and take it along for identification.

With all the above said it is highly unlikely that a snake will bite you. Look what is on the otherside od a rock or piece of wood that in in your way. Snakes, especially puff adders love baking in the sun this time ogf the year. Do not put your hand in holes and into places where you cannot see what is inside. Snakes love wood piles, there is lots of mice. Be carefull when you take wood from the wood pile.

Snakes are usually more afraid of you than you of them. If you see a snake just give him some space to sail off. Never ever corner a snake and leave him no place to escape, that is when they attack. Most snake bites happens when you surprise a snake or accidently step on it.

If you are careful you have nothing to worry about. You might not even see one.

quote:

Originally posted by Dr B:

South African Vaccine Producers produces a polyvalent snake antivenom that covers the
Puff adder, Gaboon adder, Rinkhals, Green mamba, Jameson's mamba, Black mamba, Cape cobra, Forest cobra, Egyptian cobra and the black-necked Spitting cobra. They also produce monovalent antivalents for boomslang and saw-scaled viper.
I'm knot up on the distribution of snakes in Africa. Do you think that the polyvalent anivenom would cover the snakes you find in Zululand?
Dr B

Dr B,

Even though the black mamba has a more toxic venom, the snake that is considered as most dangerous in SA (and coincidentally is also responsible for the most snakebites on humans in SA) is the puff adder. The reason for this is puff adders' tendency to lie in game paths where they bask in the sun and they do not (as most others) sail away when you approach them. Having said this, remarkably few snakebites are recorded annually and less than 1% of these bites result in fatalities - with or without the use of anti-venom.

The polyvalent snake antivenom you mentioned would cover just about all of the dangerous snakes you are likely to encounter in Zululand but as Jaco said some humans have an allergic reaction to the antivenom which could be as dangerous as the snakebite itself.

Chances of getting bit by a boomslang is almost negligible.

Ernest,

Just in case you have another attack, please send me your double rifles for safe keeping!

Rusty,

I thank you for your sincere concern.

I'm scheduled for "whateveryoucallblowingupthethings" with radio waves??? on Thursday morning. Maybe you just listen to Howard Stern really loud or something?

In the meantime, I've got Vicoden by my side. I hate that stuff, though.. I really don't like to feel like my arms and legs aren't attached to my body. Why anyone would take the stuff "recreationally" boggles my mind. It makes me want to throw up.

Just before we arrived in RSA last year one of the PH's was bitten by a snake (black mamba?)
and he had a very serious reaction to the antivenom...Apparently the Doc's lost him more than once in ER and it was a real battle to pull him through...The upshot of it all, is that that in future, should he be bitten, he can't be treated with anti venom..

When we arrived at the lodge, the PH had only just returned to work. Of course a couple of days into the hunt, he and Canuck, who was hunting with him, had a close call with a couple of black mambas..I suspect he really could have done with out that!

Pete E
What are the details of how the PH was bitten
Thanks
Dr B

Judge, sounds like an ESWL: electroshockwave litiotripsy. Usually just say "s-wall".

As for why people take those for fun, people have to have a certain body chemistry to enjoy opiates. I have FAR TOO MANY in my practice that do.

Dr B,

Hopefully Canuck will chime in when he reads this as he knows the details better than I..

If I recall correctly, the PH was originally bitten on the finger tip as he was either moving some brush or sorting out an animal that had just been taken. I seem to think that he was really unlucky as the snake "almost" missed..in the end I think the PH had one puncture wound on the tip of his finger..

As they were hunting in the Northern Province of RSA, they weren't that far from a hospital so the PH wasn't unduely concerned...

The problems really started when he was given antivenom and went to anaphylactic shock including heart failure...I don't recall if the anti venom was species specific or whether it was a polyvalent antivenom, but which ever it was, it nearly killed the PH and he was told he couldn't be treated with it again..

Whether that will change in the future as new forms of antivenom are developed, I don't know. RSA used to be a world leader in research in this area, but whether that is still the case today is perhaps open to doubt.

Regards,

Pete

I found this story intrestng.
Dr B

Bitten by a Mamba!
Danie Pienaar, Head of Scientific Services in the Kruger National Park, tells his personal account of surviving a Black Mamba bite. Courtesy of Kruger Park Times.
It was about midday on a Thursday in January 1998 when Danie Pienaar came face to face with a Black Mamba and its bite.
Danie, now head of Scientific Services in the Kruger National Park, was a student at the time and tracking white rhinos near the Phabeni tributary, south of Pretoriuskop. The water was deep and he was looking for a place to cross the stream.
“I remember there were reeds on my side, when I saw a brown movement and saw the snake disappear into the reeds" he said. He identified the Black Mamba but initially thought nothing of it other than that it was a huge snake.
He was alone and was wearing shorts. A few paces on he recalls feeling a burning sensation on the side of his leg, under the knee.
“Subconsciously, perhaps I knew I was bitten because two strides on I stopped to check.†He found four blue-purple holes and a drop of blood and had his worst suspicion confirmed.
The first symptoms appeared quickly. He had a bad taste in his mouth, almost like metal, and ‘pins and needles’ in his fingertips and lips. It soon became worse and later it “felt like all the hair on my body stood up.â€
“I realized the venom was doing its damage.†Being alone, far from the bakkie and with no medical equipment on hand Danie faced daunting decisions. He only had a gun, a knife and the tracking equipment. “I was relatively sure I was not going to get to help in time.â€
For a brief time he considered settling under a tree and writing farewell notes to friends and family. Fortunately, the desire to survive burned stronger and he decided to try and reach the bakkie.
“If I had died there, a rescue team would not even know where to have started looking for me.â€
In the meantime he tried, knowing it was not the right thing to do, to open the bite marks with his knife – with little success. He tied his belt around his upper leg and with the tourniquet in place made a quick note of what had happened to him. Leaving all else behind, he took his gun and compass and ventured back to the bakkie.
“It was extremely difficult as I deliberately forced myself to walk and breath slowly to try and slow my heartbeat down.â€
He was sweating badly and by that time had tunnel vision as the poison attacked the smaller muscles.
He finally arrived at the bakkie and attempted the closest route to a tourist road, using the fire breaks and, at times, almost getting stuck in streams. “I probably planned them,†he said.
Reaching the tourist road, he could not find anyone and it was near Shaben Koppies that the first car came by.
“They must have thought a weirdo was on the attack as I was doing130km an hour, forced them off the road, jumped out without a shirt and gun in hand.â€
The two ladies and a gentleman rushed him to Pretoriuskop where he found ranger, Tom Yssel. He explained what had happened and recalls how Tom told his wife: “A Black Mamba has bitten Danie,†not thinking that their eldest son is also named Danie, and she thought he meant the boy.
The doctor in Skukuza advised them to go to Nelspruit, but that a helicopter was not available and they had to go by car. The trip to Nelspruit, in a friend of Tom’s Combi, was done in record time, with a police escort around White River helping them on.
He arrived at the hospital, about two hours after the time he had been bitten. By this time, the symptoms had intensified, but he could still communicate sufficiently to tell the doctors what had happened. Because of the time frame, they were skeptical, and told him he would be ‘monitored carefully’.
“Even my father, when speaking to me on the phone, tried to convince me it was not a Black Mamba.â€
As the doctors removed the tourniquet, his condition deteriorated rapidly. Suddenly he could not swallow, and his speech slurred. He tried to tell Tom not to switch the machines off, as he remembered how a snake expert in the Magaliesburg had an experience where he could hear the people contemplating switching the life-support off as they thought he was in a coma.
The doctors put him on the ventilator and he was briefly knocked-out. When he came to, he was completely paralyzed, yet he could touch, hear and see everything. “I could only see if they lifted my eyelids to check my pupils, but there was nothing wrong with my sight,†he said.
It was the same situation as the man from Magaliesburg. He was restrained to the bed and recalls how his sweat dammed on the plastic sheeting in the hollow of his bed.
The fan was on and he was freezing, but could not do anything. By 18h00 that night, his friend Dewald Keet visited. He urged Danie to try giving him an indication if he can hear anything.
“With great difficulty I managed to slightly move a foot,†which Dewald luckily noticed. They then realized he was not in a coma. Slowly he regained more muscle function, as the venom molecules were flushed out of his system.
The following morning his parents had arrived. He was still on the ventilator and not fully recovered from the paralysis.
“Being attached to the ventilator with a thick pipe down my throat was the worst part physically,†says Danie. The pipe was removed on the Saturday and he left for Pretoria in his parents’ care on Monday. He never received any antivenin. Other than the sweating that continued for some time and the bite marks that remained purple for a while, Danie suffered no consequences.
On his first day back in the field, the first thing he encountered was a Black Mamba in the road!
A few months later he told the story to a friend, who happened to have a similar experience soon after and was able to tell the doctor what had happened without having seen the snake that had bitten him. The doctor, after examination and questioning him, administered the antivenin which saved his life.
Danie believes he survived for a number of reasons. “Firstly, it was not my time to go.†The fact that he stayed calmed and moved slowly definitely helped. The tourniquet was also essential.
“It was not easy to stay calm,†he says. “It was almost as if I dislodged myself from my body and was talking to someone else the entire time.â€
“I also knew snakes and have never been scared of them,†he said. The experience has not left Danie with antagonism towards the Black Mamba. “Snakes do not eat people. I was on my way and cut the snake off from where it wanted to go.â€

by Lynette Strauss, Kruger Times

It is certainly good to see and hear that you are well and still able to type. We have all missed your repartei or however it is spelt.
Glad to know you have survived enough to be thinking about doubles and any future hunts you can manage. Take care and next time you visit plan on spending some time and maybe sharing another story or two.
Frank