14 minute read
UAB program offers multidisci- plinary, cutting-edge care when snakes bite
By Matt Windsor
If you’re a gardener or an outdoorsy type, you probably know the dangers snakes can present. But do you know a first-of-its-kind Comprehensive Snakebite Program is available at the University of Alabama at Birmingham in case you do get bitten?
The program includes one of the nation’s first dedicated snakebite follow-up clinics, which treats patients in the hospital, provides long-term follow-up and studies new approaches and protocols in venomous snakebite care, according to a press release from UAB. The team also is pioneering new methods and is working toward a bet-
ter understanding of the medical consequences of snakebites.
Death from venomous snakebites is rare; only five people on average in America die from snakebites each year. But snakebites can have serious long-term effects.
“So many people – in the Southeastern United States, especially – have persistent wounds, bad swelling and morbidity issues after snake envenomation, and there was no good place to send them for follow-up,” said Dr. William Rushton, associate professor in the UAB Department of Emergency Medicine and co-director of the snakebite program.
He also is a medical toxicologist and medical director of the Alabama Poison Information Center, based at Children’s of Alabama. In the heart of snakebite season, Rushton and fellow medical toxicologist Dr. Sukhshant Atti average one or two snakebite consults every day with providers throughout the state.
Rushton and wound-care expert Dr. Dag Shapshak, associate professor in the Department of Emergency Medicine, launched the snakebite program last year.
Shapshak, of Mountain Brook, also runs the UAB Comprehensive Wound Care Clinic and specializes in treating persistent wounds and swelling. Most of his patients in the wound care clinic are about 80 years old and dealing with complications from diabetes or cancer.
“Our snakebite patients are much younger, from 5 to 30 or so, but the same techniques apply,” Shapshak said in the press release, “and they can make the difference between lifelong complications and a full recovery.”
The snakebite clinic is staffed by toxicologists, wound-care experts, pharmacists and physical therapists to give patients full-spectrum care.
Snakebites are rare enough that any given doctor may not see many patients who have complications, said Dr. Matthew Kelly, co-medical director for Wound Care and Hyperbaric Medicine at UAB.
As a result, clinics don’t stock a lot of antivenom and may not have what patients need when they need it.
“Snakebites can be intimidating to treat given all of the various scenarios in which patients can present,” Atti said. “This can create a lot of uncertainty for a community physician in trying to decide whether a patient needs to be transferred to another hospital for further care. We’re able to guide physicians in such scenarios, allowing them to make sound decisions.”
Kelly, who lives in Homewood, reiterated that thought.
“With the snakebite clinic, we are able to see patients from throughout the state and, as with many things, experience is key in understanding the nuances of clinical care.” The clinic provided follow-up treatment after snake envenomation to 17 patients in 2021.
That includes a teenage cheerleader with lingering complications and a truck driver with severe envenomation and necrosis that threatened his job and his ability to play guitar, according to the press release.
Snakebite Season in Alabama
UAB Program Offers Multidisciplinary, Cutting-Edge Care When Snakes Bite
Courtesy UAB
William Rushton, M.D., co-director of the UAB Comprehensive Snakebite Program says “So many people – in the Southeastern United States, especially – have persistent wounds, bad swelling and morbidity issues after snake envenomation ...”
Multidisciplinary Approach
The snakebite program uses lower doses of antivenom and has shorter patient stays than many other hospitals, typically discharging patients in less than 24 hours.
It’s the follow-up care and multidisciplinary treatment plans that set UAB’s clinic apart.
“We will keep seeing people as long as they have persistent wounds and swelling,” Rushton said. “What we’re doing is cutting-edge. No one else is thinking this deeply about snakebites and follow-up.”
While patients are in the hospital, physical therapists emphasize early range-of-motion exercises and getting patients out of bed. Rushton said UAB pharmacy expertise has been crucial with the timing of the antivenom. Patients then get follow-up in the snakebite clinic.
“Leaving the hospital after a snake envenomation experience can create a sense of ‘now what?’” Atti said. “Many patients find their questions unanswered, including ‘Do I elevate my limb? Do I do physical therapy? How long will the swelling last?’ and ‘When can I get back to work?’ I believe that having a place to follow up with snake envenomation experts provides comfort to patients that they are not on their own when they leave the hospital.”
Dangers of Snakebites
Snakebite season in Alabama and the Southeast runs from roughly midMarch to mid-November, and most bites occur in the evening.
About 10% of envenomations in Alabama are from rattlesnakes. The rest are from other pit vipers, including copperheads, cottonmouths and water moccasins. Doctors are quick to distinguish envenomation from the more allencompassing term snakebite, because up to 50% of bites are dry, with no venom injected.
The most common complications from envenomation are local wound damage, swelling of extremities and severely painful blood blisters. When a snake envenomates a person, often on the foot, the tissues fill up with blood.
“For someone with little experience of snakebite, that swollen leg can look like dead, necrotic tissue that needs to be removed to avoid wider damage,” Rushton said. “That’s a hallmark of our program, to keep people away from unnecessary or harmful procedures.
“These large blood blisters are cared for by a wound-care specialist who has specific training of the mechanisms of envenomation. What we don’t want is someone trying to cut away that tissue, at least early on during active envenomation.”
Cutting-Edge Diagnoses
The Comprehensive Snakebite Program is an innovator in the use of thromboelastography, or TEG, a method of precisely studying blood coagulation, clot strength and clot stability.
TEG can provide a more rapid answer than traditional tests, such as prothrombin time and partial thromboplastin time tests. Because the Department of Emergency Medicine is a national leader in research, access to TEG is widespread enough that every snakebite patient admitted to UAB can benefit from the technology and have their antivenom titrated appropriately, Rushton noted in the press release.
Even though rattlesnakes make up less than 10 percent of envenomation in the Southeast, rattlesnake bites can cause life-threatening coagulopathy.
“We don’t want to miss those,” Rushton said. “The reason we get TEGs on every snakebite patient is to screen for rattlesnake bites that may have been erroneously reported as copperhead bites. If that is the case, we will be more aggressive about giving antivenom, and we use the TEG to titrate the antivenom dose as well.”
Although the evidence is still out on whether TEGs are better than traditional labs, Rushton says the team can predict rattlesnake bites on the thromboelastogram earlier than from traditional coagulation markers.
One of the new structures will include a suspended indoor track, a pedestrian walkway and a covered balcony that overlooks Bobby Bowden Field.
Courtesy Samford University
Samford Launches Its Largest Capital Project, to Create Athletic and Recreation Complex
Samford University early next year will begin work on a $65 million project to enlarge and renovate existing buildings and create a state-of-the-art recreation and athletic complex.
The undertaking is the largest capital project in the university’s history, according to a statement from the school, and is part of a comprehensive plan for expanded student recreation, health and wellness.
It also will include new spaces for campus events and student gatherings. Additional facilities will provide new practice and training spaces for the university’s 17 Division I athletic teams.
Construction includes investments in four buildings totaling 154,000 square feet. • Seibert Hall will be redesigned to include two basketball courts, a new multi-use court, studios for fitness classes, an e-sports studio,
From page 8 dance studios, state-of-the-art weight and cardio machines, a multi-purpose workout area, and common areas for students to gather, including lounge areas, a coffee house and a 24-hour convenience store. • Bashinsky Field House will be refurbished and will be a dedicated facility for Samford student-athletes, including new training spaces for teams and practice spaces for the men’s and women’s basketball and volleyball programs. • A third building will be constructed adjacent to Seibert Hall and provide 20,000 square feet of recreation and event space. The new facility will include a suspended indoor track, additional basketball courts and cardio spaces, sound and staging to host campus events, a catering kitchen, covered outdoor athletic space, a pedestrian walkway and a covered balcony that overlooks Bobby Bowden Field. • The first floor of the Dwight and Lucille Beeson Center, which is directly across the street from the complex, also will be renovated to serve as the new home for the university’s health center and counseling services.
The project also is aimed at helping recruit and retain future students and student-athletes.
“This project represents a substantial investment in the health and wellness of our students. We are committed to supporting our students in their educational and spiritual
journeys, and we also want to support them in their physical and mental wellbeing,” President Beck A. Taylor said in the statement. “This new facility will enhance campus life and provide students with spaces to gather, exercise, socialize and participate in numerous recreational activities.”
“Students want to lead a healthy lifestyle and we want their university to provide them with opportunities to do so,” Taylor said. “From physical fitness and recreation to counseling and health services, this facility will meet students’ needs in mind, body and spirit.”
The university is funding $45 million of the project with current resources and is working to secure $20 million in philanthropic gifts.
Samford has partnered with Hoar Construction and Davis Architects to design and build the complex.
The complex is expected to be completed before the start of the fall 2024 semester.
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WE’RE ON VACATION! Over The Mountain Journal will return with our next issue July 14.
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Formerly located in Homewood and owned by long-time Vestavia Hills resident Mike Barnett, Alabama Gaslight & Grill offers a wide selection of gas grills & smokers, gas & electric lighting, and gas logs. Combined with Hollywood Pool’s outstanding inventory of pool, spa, and patio furnishings, the Vestavia Hills location is your one-stop shop for outdoor products from local families you know and trust.
Courtesy
Dr. Charles Clark shown above with his son Paul at the time of his birth. Last year the two formed a father-son neurosurgical team.
Like Father, Like Son
From Page One ment is working out well.
“It’s been great,” said Dr. Paul Clark. “Dad has 40 years of experience, so he’s seen and managed almost everything in neurosurgery. He’s always available to review a case with me or provide advice, and I have three other partners who do the
same for me as well. There are different ways to approach a problem in neurosurgery and having that experience to tap into when making decisions has been invaluable.”
But, acknowledged Charles, having a young partner in the practice has advantages, too.
“He knows about new techniques, and I have experience,” he said. “And we usually agree about surgical treatment for patients.”
Career Path
While many fathers make a full-on effort to influence their sons to follow in their footsteps careerwise, Charles had little to do with his son’s decision to become a neurosurgeon. He said his only hope was that his son become “happy and successful in whatever he chose to do.” Paul was in charge of determining what that was.
The younger Clark first considered a future in biomedical engineering and, with that thought in mind, he earned a bachelor’s degree in the field.
“I was always math- and scienceoriented in school,” he said. “But I initially couldn’t decide if I wanted to pursue medicine or engineering.”
Though he obviously didn’t follow the latter career path, Paul’s engineering background, his father believes, is helping him succeed as a neurosurgeon – that, plus intelligence and what Charles termed “good common sense.”
Paul is the youngest of three Clark children, and he is the only one to go into the medical field.
Even after Paul opted for a career in medicine, he felt no pressure from his father to choose neurology as a specialty. In fact, he once strongly considered plastic surgery as his calling.
“We never talked about medicine when I was growing up,” he said. “He came to baseball and basketball games, took my brothers and me golfing and to college football games. He never tried to influence us as to our career choices. He provided opportunities to us that we were very fortunate to have and let us make our own way and decision.”
When asked what makes the other a good doctor, the Clarks’ responses revealed a common dedication to patient care.
“He does the right thing and cares for the patients,” Charles said.
But Paul’s response said just as much about his father as a doctor as it did about his father as a father.
“He connects with his patients,” he said. “He is always thinking about what he would want for himself or his family and applies that to his patients.”
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Whiskey with no diluted ice. Perfect for the Dad that has everything, Whiskey Wedge, $25. The Cook Store, 205-879-5277.
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Men’s sterling silver and sterling silver and gold Phillip Gavriel bracelets. Ranging from $295-$400. Southeastern Jewelers, 205-980-9030. Goldens’ Cast Iron offers a superior kamado grill with stainless steel shelving constructed of high-quality, durable American-made cast iron. Hollywood Pools, 205-979-7727.
Tantalum Bands starting at $469, Gold Bands starting at $459. Shay’s Jewelers, 205-978-5880.
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