CHRIS KNIGHT, The Patriot-NewsDr. J. Ward Donovan, medical director of PinnacleHealth Toxicology Center, left, confers with Dr. Nick Dowling, a toxicology resident, in the unit on the 10th floor of Harrisburg Hospital. Alvin Osborn has been catching rattlesnakes for 34 years at the Morris Rattlesnake Roundup near his Tioga County home, always careful to tell young onlookers just how dangerous snakes can be. Last month, he experienced it firsthand when a snake rose up in an instant and bit two of his fingers. I could feel a needle stab and it got warm and then a tingling, Osborn, 51, said. Then my tongue was tingling. Ouch! It was awful pain, but I knew youre supposed to try to stay calm. He was taken by ambulance to a hospital in Wellsboro, where anti-venom was started. He was transferred to Geisinger Medical Center and, finally, to Harrisburg Hospital, the only hospital in the United States with a unit dedicated solely to the care of toxicology patients, according to Dr. J. Ward Donovan, founding director. The PinnacleHealth Toxicology Center, which opened in 2003, fields phone calls on poisonings from more than 50 hospitals in central Pennsylvania and beyond, and maintains an in-patient treatment unit for seriously poisoned patients. Rather than manage him over the phone, we decided to bring him here, Donovan said. There are a lot of myths about snake bites and how to treat them. If you get severe pain, swelling, lightheadedness and dizziness, theres only one treatment get to the nearest hospital. Avoiding snake bites Pennsylvania is home to two kinds of poisonous snakes: timber rattlesnakes and copperheads. Though their bites rarely are fatal, the longer it goes before treatment is started, the worse the swelling, the pain and the potential for loss of limb due to compromised blood flow, Donovan said. Osborn was bitten after he had caught one rattlesnake and was trying to help another man get one out from under a rock. I was about to reach in with my tong to get him, but I guess he was mad because somebody was poking him from the other side, Osborn said. Osborn had twice seen his father get bitten by a rattlesnake during the roundup so he knew what to do and what to fear. My father almost died. There was a moment where I thought I might die, too, he said. Osborn did the right thing by trying to stay calm, Donovan said. If you get your heart rate going really fast, it can increase circulation of the venom throughout the body, he said. Two days after the bite, Osborn lay in a hospital bed with his arm suspended from an IV pole to keep the swelling down. The pain is still pretty intense, he said. The anti-venom is made from the blood of sheep that have been inoculated with the venom so that they produce antibodies to it. The blood is separated so the proteins most likely to cause allergy are removed from the anti-venom, Donovan said. In addition to anti-venom, Osborn received heavy doses of morphine intravenously and physical therapy was started to help him maintain use of the injured hand. Upon discharge from the hospital, Osborn is expected to remain on oral pain medicine for one to two weeks while swelling and pain persists. He also will be monitored by his doctor at home to see if more anti-venom is needed. Often anti-venom leaves the body faster than the venom, Donovan said, and that could trigger a recurrence of the initial intense symptoms. Sometimes people are unsure of what kind of snake has bitten them, Donovan said, but the answer lies in the reaction. If you think you were bitten by a black snake but you start swelling and have pain up your arm, that was not a black snake. A nonvenomous bite causes just localized swelling. Donovan advises leaving snakes alone. Most snake bites are due to careless behavior around snakes or people trying to handle them. You should always be six feet back from a snake thats how far it can strike, he said. Treating poisonings Snake bites make up only about four to 10 of the 1,200 cases treated annually at the toxicology center. The majority of cases are drug overdoses, whether intentional or accidental. We live in a very pill-oriented society. As a result, poisonings between ages 15 to 55 many of them drug related are the No. 1 cause of accident-related hospitalizations and fatalities more than gunshot wounds, suffocations, drownings and motor vehicle accidents, Donovan said. Suicide attempts are the No. 1 reason for the overdoses seen at the unit, but many are also due to misuse and overprescribing of pain medications, whether someone is buying them on the street or getting them from a doctor, Donovan said. In the hospital, patients are treated with an antidote to try to reverse the effects of the drug and with critical care support such as respirators, Donovan said. Right now on the floor I have three young people age 18 with severe narcotic overdose resulting in multiple organ failure, he said. All three are waiting to go to a long-term neurorehabilitation center.Donovan has noted a dramatic increase in drug poisonings since 2005, in part, he guesses, because of overprescribing of pain medicines and an increase in recreational drug use among young people. Donovan has treated patients as young as age 13. People picture drug addicts as being of a lower socio-economic class or a certain ethnic background, but in reality, the epidemic crosses all socio-economic backgrounds and geographic areas, Donovan said. Expansion planned The toxicology unit, which will soon expand from 10 beds to 24 beds, also sees patients who have been poisoned by industrial toxins, such as industrial strength bleach, or hydrogen sulfide, a gas produced in manure pits. The center is intended for the seriously poisoned patient, Donovan said. Poisonings by household chemicals or personal care products are treated in the emergency room or handled by a poison control center, he said. The toxicology center, as part of PinnacleHealths toxicology program, includes 29 full-time positions for nurses specially trained in the care of poison patients, social workers, psychiatrists, nurse practitioners in psychiatry, a nurse educator, nurse unit manager and a nurse program manager. In addition to Donovan, there are two part-time attending physicians, and there are plans to add a second full-time doctor. Residents from six training hospitals in central Pennsylvania do their toxicology rotations at the center. Few hospitals are willing to support a toxicology unit because its not a glamorous, money-making field for a hospital. PinnacleHealth recognizes the problem and has dedicated resources to serving this population of patients, said Donovan, who formerly taught at the Penn State College of Medicine and was the director of the poison center at Penn State Milton S. Hershey Medical Center before it closed in 2003. The center serves all of central Pennsylvania, and about 60 percent of its patients are transferred from other hospitals. As for Osborn, he says hes retired from hunting rattlesnakes, much to his wife Sues relief. I was mad at him, she said. I think its crazy for someone to go out and try to catch something thats poisonous. I agree with her, her husband said. I love hunting rattlesnakes, but Im done. I never want to have this kind of pain again. Tips to avoid drug interactions and overdoses: PinnacleHealth Toxicology Center does not take calls from the general public. Public callers seeking advice about poisonings should call the National Poison Help Line at 800-222-1222. Source: Dr. J. Ward Donovan, PinnacleHealth Toxicology Center
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