Episode 48: Animal bites! Snakes, spiders, and bats, oh my! with Dr Michael Levine

This is a part 2 episode of Ask Dr Jessica with toxicologist Dr Michael Levine.  In this episode we talk about all of the creepy, crawly animals that most of us want to avoid!  We talk all about snake bites, spider bites (including black widows, brown recluse and scorpions), and what to do if bitten by a squirrel, raccoon, bat or other potential rabid animal. Dr Levine provides great information giving parents the tools to know what to do if ever bitten by an animal, and when to seek medical attention.

Michael Levine MD is a toxicologist and he is on faculty at UCLA hospital in Los Angeles.  

 Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children.  Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. 

Do you have a future topic you'd like Dr Jessica Hochman to discuss?  Email your suggestion to: askdrjessicamd@gmail.com. 

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The information presented in Ask Dr Jessica is for general educational purposes only.  She does not diagnose medical conditions or formulate treatment plans for specific individuals.  If you have a concern about your child's health, be sure to call your child's health care provider.

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

Follow her on Instagram: @AskDrJessica
Subscribe to her YouTube channel! Ask Dr Jessica
Subscribe to this podcast: Ask Dr Jessica
Subscribe to her mailing list: www.askdrjessicamd.com

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

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Hi, everybody. Thank you for tuning in to this week's episode of Ask Dr. Jessica. This week is part two of my conversation with toxicologist dr. michael Levine. So toxicologists, in addition to being experts on medications, they are also experts when it comes to animal and insect bites. So in this episode, we talk about some of my greatest fears, including but not limited to, snake bites, spider bites, Scorpion bites, and even bat urine. So thank you so much for listening. And if you do get an opportunity, I would be so grateful if you would rate review and subscribe to this podcast. And even better, I would love it if you would share this podcast with a friend, Dr. Levine, can I ask you about typical bites that you deal with that are problematic for kids or potentially problematic? What are the most common calls that you get about animal bites on children? Not from a toxicology standpoint, but from an emergency standpoint, far and away into the dog. But in terms of from a toxicology standpoint, sometimes spiders make way more often people blaming spiders for their skin infection that has nothing to do with the spider, and then sometimes Snake Snake animations as well. Can you tell me any advice for parents in terms of avoiding snake bites and how to handle snake bites? Yeah, so one of the probably the best way to avoid a snake bite is to avoid the snake. So if you're outside, you're hiking as you did on your on your recent podcast. Really try staying in the middle of the trail. Try avoid walking through a little brush areas, if you're going to sit down, especially some snakes, or some rattlesnakes, specifically, like hiding in rocks and stuff. Just be careful where you sit where you reach your hand. And similarly if you're out in the garden, but watch where you put your hands before reaching for the volleyball or trimming the rose bushes, snakes hide in bushes. And sometimes people get big because they're reaching in the snake thinks you're trying to reach for it. You're trying to reach for the rose bushes or the tennis ball or whatever it is that sitting in the bushes. And the snake thinks you're reaching for it. You're reaching for the ball and the snakes usually faster than you are and bite you. So avoid the snake watch where you're putting your hand watch where you're walking. Wear shoes, especially a covered shoes, not flip flops, and ideally up the cover pass through the ankles. So if somebody is on a hike and they see a snake, what advice would you offer should they should they turn around and run away should walk away they shouldn't run away. So okay, especially if you see a coiled snake remember, snakes can lunge about half of the body distance. So it don't, people often will try stepping over a snake or walking right past the snake or they see the snake on the trail, they think well, I'm just going to walk immediately next to him if two inches away from the snake or I'm going to gently step over the snake and never goes well. So if you see a snake stop, take several steps back slowly. And then wait the often the snake is just going to be like slithering across the trail. And if you wait two or three minutes, that's going to go on to the other direction away from you. And if it's really just sunbathing, it's getting around dusk and stuff, and then just wanting to enjoy a little bit more of the heat from the side of the road or from wherever it is. They may wait there 1520 30 minutes, just wait if you either wait there or turn around and go back. But don't try walking around the snake. If you're on any normal sized path, you're just not going to be able to safely walk around that snake. Now, in your experience, are our baby rattlesnakes different from mature rattlesnakes not really interested in how much he talks about the or the baby doesn't know how much in venom to inject. So it injects everything. There's really not a lot of evidence for that. And there's maybe a small amount of evidence that the largest snake may actually inject slightly more venom. There is some data that the components of the venom change between a juvenile snake and an adult snake, but it really is hard to mess. I've seen people get really sick from very little snakes I've seen people do just fine from little snakes. And I've seen people get very sick from very large snakes and people be absolutely fine from large snakes as well. So there's really no clear rhyme or reason. And once people get bad do you have advice for how they should proceed? I mean, I've heard people I just want to clarify a lot of myths out there. Some people think they should suck out the venom in the bite. Or don't put a tourniquet on so don't suck the venom. Don't put tourniquets on, don't put ice on. Don't incise the venom or the bite. Don't. Don't suck on the wound. Don't use shock therapy on the wound. Bed basically, calmly as much as you can, which I realised sounds kind of like a stupid thing to say Oh, stay calm. So your child was just bitten by a deadly snake but stay calm. But most of the vast majority of the snakes are going to be absolutely fine. The snake bites are going to be absolutely fine. Even among rattlesnakes, there are going to be just fine. It's really really unusual to actually get truly critically ill or die in. It does occasionally happen but it's really rare. So the best thing is stay where you are take a couple of steps back away. From the snake, and then and then once you've moved several feet away, call 911. And tell them where you are. And they could usually trace down exactly where you're calling from if you dial 911. With most EMS systems have what's called Enhanced nine, we want to make it look where your signals from different cell phone towers and really track down pretty close to where your call is coming from, even on the side of a mountain, and they can read to you pretty easily. So if you do or you don't have cell reception, then slowly hike back to an area that you do. And then when they get to a hospital or medical facility that hopefully has the treatment for them. Do you find that that makes a difference? Or what in your experience? In your experience? are hospitals helpful in terms of treating bites? Yeah, so there's there's a couple potential things. So there definitely are some guidelines hospitals can call poison control or talk to a toxicologist if they don't have on most hospitals don't have a toxicologist on staff, or anyone specifically trained in snake bites. And I don't know about you, but certainly most most paediatricians have seen either none, or have had maybe a snake bite at some point in their residency. And the vast majority have almost no formal training. And, and that's true of adults with internal medicine as well. So ideally, there is a little bit of data that you have improved care on multiple different levels, if you have a toxicologist involved in your care versus if not, but really just go to any, any hospital, or any emergency department, and they should be able to take care of you. And then if they don't feel they have the capabilities, they can always transfer you at that point or talk to someone that does. And can you talk about the medication that's given for snakebites? Yeah, so in North America, there's or in the US specifically, there's three different types of Chrono lids. And then there's a type of elapid. That's dangerous. So the last one is the coral snake. And there's a couple different ones, there's the Texas the Eastern and the Sonoran, call snake. And then in terms of for the credit cards, there's rattlesnakes, copperheads, and cottonmouths. So for the pit vipers or the Crota LEDs, you actually have two antivenoms that are now available. One is called Ana VIP. And one is called crow fab. And those are the brand names for them. And they're slightly different. They're made from different snakes, they have slightly different benefits, each one is slightly different benefits are in slightly different downsides compared to the other one. But they're both effective for treating rattlesnake bites, or really any of the North American Pit vipers. I just want to say I'm so grateful for you, because for those of you listening, I actually met Dr. Levine because he treated my nephew for a rattlesnake bite that he had a few weeks ago. And you're absolutely right. In my 11 years of practice. He's my first rattlesnake bite that I've experienced my nephew. And my dad who I practice with, he's been practising paediatrics for 40 years. And this is his second rattlesnake bite. So it is interesting for how much we worry about rattlesnake bites are actually not very common, or, you know, in our day to day lives, it's not something that we experienced very commonly. But thank you so much. No, of course, thank you. My, my sister and my brother and I were so happy because they said, You were so experienced and knew what you were talking about. So I'm very grateful. Well, thank you appreciate it. And is the medication hard to come by? It depends most many hospitals carry at least the initial dose. Some hospitals don't. So if you're in an area that's used to seeing snake bites, they generally carry it but not all do. And if you're in an area, that's if you're in downtown Los Angeles, and most of the hospitals probably are not going to carry or be much less likely. So it's really kind of depending on where the hospital physically is located and how likely they are to see snakebite is expensive. So a lot of hospitals have to deliver SeeSnake right, they don't necessarily carry and the half life isn't very long, right? Doesn't it expire to the shelf life. Okay. Okay, that's good. Since since my nephew's had his snake bite, a lot of my sister's friends and family have said they don't want to hike anymore because they're nervous about getting a rattlesnake bite. What do you think about this, like, in your experience, after seeing so many bites? Does it make you nervous about hiking? Or do you think you can do it safely? I think you could do it safely. Again, I would just kind of watch where you're hiking. Try making some noise. Don't walk through a bunch of leaves at the corner of the bushes or the leaves at the corner of the trail. And just watch where you're walking. And the one other thing is, a lot of people put in like your air pods or earphones or whatever, while they're out there hiking, snakes not all the time. Maybe not even the majority of time but frequently rattlesnakes have a are called rattlesnakes for a reason they have a rattle. If the snake feels threatened, it will stop make some really loud sound, which is trying to warn you that the snake is here and not to get close to it. So if you're wearing some ear things listening to music and not paying attention, you're less likely to hear the rattle. So just be aware of it and probably in Los Angeles, probably half of the snake which is very different than Arizona. So when I was in Arizona, tonnes of people got bent hiking, tonnes of people got hit, guys, I got bit while they saw the snake, they tried to move it, they tried to step over it, this poor snake is gonna get run over, let me move it off the street off the freeway or off the street before someone drives over it. It never goes well for them, the snake is always just fine, the person's not fine. So that doesn't go in Los Angeles, way more of our bites or people accidentally don't see the snakes are not paying attention. Or they step out of there on their porch and there's a snake sitting on their porch they open the door and there's a snake sitting on the porch they step on it or they're out in their garden reaching for something or gardening are probably half of the people that we see in Los Angeles are gardeners meaning half that is with rattlesnake bites. My my There's a story in my family. My grandma did that she was gardening and she picked up what she thought was a hose and it turned out to be a garden snake. It's a famous story in our family. Fortunately, and she's I'm sure she's fortunately I'm sure she's probably fine. And fortunately garden sinks generally don't cause anything other than maybe a little bit of wound issue but like a little puncture wound. But yes, people definitely see snakes in the garden or sometimes don't see snakes in the garden. Right now. I think the story goes, you know, my grandma's case all that result, it was a really loud scream that I think all the neighbours heard, but she was fine. Snake was probably more scared than she was. Right. Okay, now what about spiders? So I have to admit, spiders are something that I am not a fan of. I know they're good for the environment. I know they're good for the ecosystem. But I am a little bit arachnophobia. Ik how, how common are harmful spider bites? And do you have any advice? Yeah, so it slightly depends on where you are. But for the most part, most spiders are not going to hurt you. Most spiders are not going to cause problems. Spiders very, very rarely are going to be like, Ooh, there's a person over there. I want to get revenge because they stepped on. On the My cousin yesterday. They're not looking to bite people. Right? There's Well, obviously not in Los Angeles. But there's there's stories from places like the in parts of the Midwest or in the south where there are where the recluse is. And the exterminator goes in the house and finds that there's 10,000 Different brown recluse is living in someone's basement. They've never even seen every single one or knew about them before. So they're people. People definitely, obviously a bit by spiders, the vast, vast, vast majority of spider bites are from non toxic spiders that are that are not going to cause any problems other than maybe a little welt or a little local redness. I think the bigger issue is that people frequently will blame. It's a brown recluse. So if you're in California, there is not a brown recluse and 1000s of miles from you. So there's not they're not in California, they're not in Arizona, they're not in New Mexico, you're talking now over into the eastern part of Texas before you realistically expect to see a brown nucleus. So that little spider deciding to walk all the way across multiple state lines is probably not going to happen. So way more often than not, it's they have some local wound infection from a could have started from a spider, it could have started from a puncture wound from anything. And they have a little infection that little spider gets blamed way more than it probably deserves. So you're saying oftentimes when people have a welts that might look like a spider bite to them, it's actually an infection like a bacterial infection. Correct. Okay. And I've heard also the name brown recluse, you know, reckless was given for good reason, because they're constantly hiding, and they're not actually, you know, going to be found coming after humans are more likely to be found hidden. Now, what about the famous black widow spider? What what signs should families look for? And are they a cause for concern in California and other sorts of black widows in California, we actually have black widows and pretty much every state in the US other than Alaska and Hawaii, but they're in all 48 contiguous states in the US. So patients can get bit by black widows, they you can see a couple of things. So at the wound site, you can see a little looks like a little Bullseye type of appearance, like a little red area, followed by a little white area followed by another little red circle, and that can last for several hours, patients will often have a lot of back pain, a lot of abdominal pain, you may see what's called for circulation. So like the muscles are kind of doing that one of these kinds of little tremor type things in the extremities, that people could get really sweaty, and you can see then some the heart rate and blood pressure and stuff can go up a lot in there and a lot of pain. So that's a higher envenomation from a black widow. But you definitely can see them. And you can see them in kids. And you can see them and adults and you can see them and pretty much everyone in the middle. And if somebody does get bit by a black widow, what should we do? Should we wash it off? Should we take payments? Local wound care, I'm saying wash it off. And if you start getting symptoms, you could either go at that point, you could call poison control, you could call your doctor or you go to an emergency department. But if you're asymptomatic from a spider bite, I wouldn't, right. You don't need to rush straight to an emergency department just because you saw, even if you clearly identified as a Black Widow. What about tarantulas? I've seen tarantulas in the wild, are they? Are they dangerous? No, not really, are not in the US. So just back me up. By the way, just to just to back up for one second. In the United States, there has never been a death due to a black widow. There have been several deaths due to treatment for the black widows, due to people having allergic reactions to the anti venom that's given. But there's never been a drink death directly attributable to the Black Widow in the United States. You're helping me with my fear of spiders. I still hate on them. And now what about tarantulas? I've seen tarantulas before out in the wild, and they've made me nervous. Is that Is that a reasonable fear or, or are strange? Absolutely a reasonable fear. They're huge spiders that look like they're gonna come after you. And they're big and fast, and they look scary. It's absolutely totally appropriate to be afraid of them. You don't need to be they're not dangerous, really. But it's absolutely appropriate to be terrified of a tarantula, and they look like horribly mean spiders that come out of some horror movie. But with regards to D actually, cause problems, know, they get wood, they feel threatened, they kind of start shivering, and they go like this one of these little things, and they flick off all their little hairs and the hairs fly at you. And it's like little beestings it gets into your skin and it's irritating and itching, but it's not really dangerous to humans. Is there any other kind of spider that we should be aware of? Or pay attention to? Don't really? Now what about you mentioned scorpions? Are Scorpion bites a cause for concern? Is there any advice for families if should they see a scorpion? So the bite No, the sting potentially. So it depends where you are. So score Scorpion Sting there, they grab onto whatever they were, they're modelling real pictures, and their tail flips up and down this little Stinger at the back of the Talon and tries injecting venom into whatever it's going to. So when you're thinking of scorpions, it really depends on where you are. So in the United States, the only potentially dangerous scorpion is what's called the bark scorpion. And that really lives just in Arizona. You may see it very, very, very infrequently, right at the very eastern edge on California, the very western edge on New Mexico, in the very southern part of Texas, coming up from Mexico there occasionally there, but for the most part of the bark scorpion is pretty much confined to Arizona. You can they look very similar to many other scorpions. They're like an inch, inch and a half long, they're tan. They're, they're pretty nocturnal, they bark scorpions, the only one that knows how to climb vertically. So if you see a scorpion climbing up a wall, that's a bark, scorpions, none of the other scorpions can climb vertically. But there and those could potentially be dangerous. So even if you're in Arizona and you get stung by a scorpion, I would initially not do anything if you want, you could call poison control, and they could walk you through it. And even in children, most scorpion stings are not dangerous and are managed at home. Okay. And I read you know, in medical school, we learned that Scorpion bites can be a cause of pancreatitis, inflammation of the pancreas. This is something you've ever seen, not in the US. So it is specifically confined to a subspecies in Trinidad, and that could cause pancreatitis. I remember that was a big question that came up on our medical board. Everyone talks about where's the pancreas involved with all this? What do you mean it doesn't happen? But it's in my pneumonic for pancreatitis, the s the scorpion stings. What do you mean, it doesn't happen? Right? Yeah, it was a little disappointing to find out. You actually don't know. Another question I have. What about rabid animals? Have you seen? Have you seen this before? And is that something that any advice for parents to your experiences and perhaps for an animal, there's there's a break in the skin, certainly appropriate to go to the paediatrician, go to the emergency department and go to urgent care if you have any concerns over things, because the the wound needs to be cleaned and may need antibiotics and may need stitches that kind of depends on this specific bite. In terms of animals that contain rabies, you're somewhat have to look at where you are, and it's pretty geographically located. So for example, in Los Angeles County, and and I imagine is probably the in the case in the vast majority of the United States, there hasn't been rabies from dog bites in years decades. So if you have a bite from a fox or a squirrel, or you have a skunk bite, or something like that, yes, even in LA County, I would be potentially concerned about that and then we would treat you for rabies. From a post exposure standpoint, we'd give you a rabies vaccine plus what's called immune globulin. If you've been best if you bitten by a dog. There's just not rabies from dogs in Los Angeles County, almost everyone gets their dogs vaccinated. And even those who don't. The there's just so much of everyone else having their dogs vaccinated. That is really, really, really unusual for dogs to have rabies. So in LA County, no, I wouldn't be worried about it. If I was going to be going on a vacation, I'm going to parts of Mexico. Yes, I probably would actually get a rabies vaccination series before. So if you're hiking in the middle of somewhere in Mexico, and you're not going to be able to have easy access to get anywhere, then yeah, that's potentially a problem. So if you're bitten, like I said, by a fox or a squirrel, or a skunk or a raccoon, absolutely, I would be concerned. And that would get that would get treated. And the first steps for parents should that happen. When you talk about cleaning the wound, any specific advice, any minute, and then call and then go see the go to the emergency room? Yeah, call it if, obviously, if you see a giant bite when there's like a big open wound, then calling the paediatrician on the telephone may not be there. Unless they could get you in that day, which is great. Maybe they could, then you may otherwise need to go to an urgent care and emergency department. But if you're a bit of somewhat depends on if it's a large open wound, then that's going to need to get fixed. That's not something that you could do over the telephone. So it's somewhat depends on on what the virus and what of the bite looks like. And your experience as a toxicologist, have you ever experienced rabies? Have you ever had a patient who has actually had rabies? That's how, you know we've treated multiple people for with that had been bitten by animals that are potentially rabid, like foxes like Fox bites, or squirrel bites or animals like that. We definitely treated patients that have been bitten by an animal that could contain rabies. The other big thing is bats. So, right bats don't actually have to bite you. If you have a bat fly into your house. Everyone in the house needs to get treated because there's rabies that goes into bat urine. And if the bat pees in your house, it can aerosolized the rabies, so everyone in the house, even if they're if they find the bat inside of your house, everyone needs to get rabies, post exposure prophylaxis. Wow. Is there a certain amount of time that a exposure needs to get treated? You know, is there a time window where they have to be you're choosing the medication around the location? I don't see we don't have many bats here in California. No, but like, when I trained up in Boston, Texas, you would have people with bats fly in the house and just the because they're not acting right if they their echolocation thing isn't working right? If they're flying in a house. So the concern is to that point that the bat was rabid. And that's why I went into your house. And then everyone in the house needs to get to you. Wow, this is really interesting. I hope I never come across this. Are there any other animals that from a toxicologist standpoint that you want to provide information to families listening? Anything from an animal standpoint is just if you're going to keep pets know what your pets are, and make sure your pets are allowed to have keeping venomous animals is probably not a wise idea, especially for anyone but especially if you have little kids in the house. Probably a poor idea to keep like your pet rattlesnake in your house. He'll monsters every once in a while. Yeah, people keep those as pets. They're not. They're primarily native to the southwest. And just if you see them, just leave them alone. They're really shy. They're not like biting people. They bite when you're they're being handled or they're really feeling threatened, but they don't just jump out and bite people. Do you feel like you're the toxicologist? You? You are extra nervous because you see so many harms? From what things that can happen, or do you feel like the opposite, and I'm certainly more probably cautious about different animals and stuff. But when it comes down to medications, it's like no big deal. So there's raid fine you spray. I remember at one point, I was like, I sprayed raid all throughout. I sprayed real like bunch of ants outside. I was experimenting with my kids. The kids had a friend over and the parents like what are you doing your radar? That's fine. And I'm just like spraying the whole thing all around a mom and toxicologists it's totally fine outdoors don't worry about and their kid the parents like freaking out what are you doing? You know, they never played together after that. Because the parents didn't like the rain. Yeah, no, they never came over at our house because of the rain. Terrifying. Thank you so much. I really appreciate your time and expertise and we'll talk soon. Sounds good. Thanks. Thank you for tuning in to this week's episode of Ask Dr. Jessica. Don't forget to take a moment to leave a review and share with a friend. Your support is what helps this podcast grow. See you next Monday.