Prevention of Dog Bites

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

I saw a young girl recently with a dog bite to her face. Her mother brought her in for me to check the scar (and remove the stitches placed in their local ER). The third full week of May is National Dog Bite Prevention Week, but it never hurts to review this information as more than 4.7 million people a year receive bites from man/woman’s best friend (and I dearly love my dogs).

Each year, nearly 1 million Americans seek medical attention for dog bites; half of these are children. Most dog bite-related injuries occur in children 5-9 years of age. Almost two thirds of injuries among children 4 yrs or younger are to the head or neck region. Dog bites are a largely preventable public health problem, and adults and children can learn to reduce their chances of being bitten.

Basic safety around dogs:

• Do not approach an unfamiliar dog.

• Do not run from a dog and scream.

• Remain motionless (“be still like a tree”) when approached by an unfamiliar dog.

• If knocked over by a dog, roll into a ball and lie still (“be still like a log”).

• A child should not play with a dog unless supervised by an adult.

• A child should immediately report stray dogs or dogs displaying unusual behavior to an adult.

• Avoid direct eye contact with a dog.

• Do not disturb a dog who is sleeping, eating, or caring for puppies.

• Do not a pet a dog without asking permission from its owner first.

• Do not pet a dog without allowing it to see and sniff you first.

Things to consider before adding a dog to your household:

• Learn about suitable breeds of dogs for your household.

• Dogs with histories of aggression are inappropriate in households with children.

• If your child is fearful or apprehensive around dogs, then don’t get one. it will not make the child less fearful.

• Spend time with a dog before buying or adopting it. Use caution when bringing a dog into the home of an infant or toddler.

• Spay/neuter virtually all dogs (this frequently reduces aggressive tendencies).

• Never leave infants or young children alone with any dog.

• Do not play aggressive games with your dog (e.g. wrestling).

• Properly socialize and train any dog entering the household. Teach the dog submissive behaviors (e.g. rolling over to expose abdomen and relinquishing food without growling.

• Immediately seek professional advice (e.g. from veterinarians or animal trainers) if the dog develops aggressive or undesirable behaviors.

Tactile Quilts

Updated 3/2017-- all links (except to my own posts) removed as many no longer active.

The Quilt of Valor Foundation has asked for tactile quilts to give to blind or sight-impaired soldiers. The tactile sense training seems to help them train the brain to "see" in other ways. The reason is not fully understood, but is known as sensory substitution. This refers to the capacity of the brain to replace the functions of a lost sense by another sensory modality. The most commonly used form of sensory substitution is Braille reading which allows the blind to read by touch (somatosensory system).

So instead of just using the usual quilting cottons, the tactile quilts are made of fabrics with interesting feel: corduroy, jeans, flannel, wool (washable), linen, pleated fabric, ruched fabric. The one constant is the fabric needs to be washable. I know that one of the things I love about fabric (and yarn) shops is "touching" the fabrics. I won't buy a fabric (or yarn) if I don't like the way it "feels" to my touch.

So I tried to find more information as to how this "touch" (somatosensory system) was so important in training the vision impaired. I found a few sources, like this study done by Nicholas A. Giudice at the Minnesota Lab for Low-Vision, Center for Cognitive Sciences,University of Minnesota, it was shown that "blind participants demonstrated activation in primary visual, extrastriate and higher level visual cortices in response to tactile stimulation, whereas sighted subjects showed no such consistent "visual" activation to the same tactile stimuli. An important new finding is the observation of functionally relevant reorganization in all three blind participants. That is, while meaningful stimuli, like the Braille, embossed roman letters and tactile shapes showed the greatest and most defuse occipital activation in the blind subjects, the presentation of tactile noise alone showed little activation in these regions. In concert with this progression of salience and functional relevance is a fairly consistent pattern of areas associated with higher visual processing being activated by the more meaningful tactile stimuli across the blind participants."

Brain plasticity: from pathophysiological mechanisms to therapeutic applications. by Duffau H in J Clin Neurosci. 2006 Nov; 13 (9):885-97

The Occipital Cortex in the Blind, Lessons About Plasticity and Vision by Amir Amedi, Lotfi B. Merabet, Felix Bermpohl and Alvaro Pascual-Leone; 1Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center

Scar Prevention

Updated 3/2017-- all links (except to my own posts) removed as many no longer active.

So the stitches are out, What can be done to minimize the scar? Scars may fade, but will not disappear.

• First--remember that the wound/cut/incision is not "technically" healed at this point. The wound is just now entering that third phase, the maturation phase, of healing. The stitches need to come out early so that there will not be "stitch marks" or "rail road marks" from the stitches themselves. The area needs to still be protected from tension. Steristrips can do this, but so can a piece of paper tape applied along (or across) the "healed" scar. Both of these allow the strip or tape to have the tension placed on them rather than actual scar. The tensions are the scar will vary depending on its location. The shoulder gets a lot of tension as use of the arm is allowed (If we didn't allow use of the shoulder, it could "freeze" up--that's worse than a wide scar.) The breast/chest skin gets some tension with arm use, but can be decreased by not allowing backward motions of the arm (ie vacuuming) or full stretching, as in reaching for the top shelf.


• Second--protect the scar from the sun. Apply sunscreen daily to the scar, if exposed (face, neck, hand), for 6 months or more. This will allow the red color (as the increased capillaries are absorbed) to fade.


• Third--scar massage helps in the "realignment" of the collagen during the maturation phase (up to two years). It is easier to do scar massage if you use something like cocoa butter, vitamin E, Mederma, Aquafor, or just a favorite lotion. The key here is to do it. Gently massage along the scar. Gently "pinch" the scar up if the scar feels like it is trying to "stick" or adhere to the underlying tissues.


• Fourth--If the scar allows (won't work on areas with great movement), silicone sheeting products can be used. It is hard to use both this and some of the scar massage suggestions at the same time. The Mederma or vitamin E, etc must be cleasned off the skin really well befor applying the silicone sheeting.

Scar revisions are not done for a minimal of 6 months, as we know that scars change, flatten, and fade. Exceptions to this rule are when the scar is obviously creating a tether across a joint (can not straighten the elbow) or deforming (pulling the lower eyelid away from the eye). If the scar appears to be getting "puffier" or thicker, it can often be helpful to inject the scar with Kenalog. This must be done carefully, as the injection can thin the scar/skin (atrophy) and decrease pigmentation in the skin. These risks must be weighed against the benefits expected to be gained.

Other things that can help with healing include: not smoking, good nutrition, and keeping other disease processes under control (ie diabetes and hypothroidism).

Basic Suture Techniques

 Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

Direct approximation of the wound margins is required for healing by primary intention. This is preferred when possible. However, if infection or excessive tension is present, then healing by secondary intention (spontaneous contraction and epithelialization) or tertiary intention (delayed surgical closure) will most likely be necessary. The following surgical axioms are important to remember in the goal of obtaining a fine-line scar that compromises neither function nor appearance:

• Adequate debridement and hemostasis. All devitalized tissue and foreign bodies must be removed. Complete hemostasis should be achieved.

• Atraumatic technique. Gentle handling of tissues is very important.

• Alignment with relaxed skin tension line. Place elective incisions parallel to the lines of facial expression. Scars can be hidden in wrinkles.

• Angle of incision. Incisions are placed perpendicular to the dermis except in the scalp and eyebrows where the incision should be parallel to the hair follicles.

• Area of body. Areas of greater vascularity (head and neck, hands) usually yield better scars than areas of lesser vascularity (lower extremities).

• Age of patient. Scarring is minimized in older patients due to decreases in skin tension and inflammatory response.

Critical elements include the obliteration of dead space, layered tissue closure, and eversion of skin margins. Deep dermal sutures align the skin edges and help decrease tension on the skin closure. Everting skin sutures are placed by encompassing a larger amount of deep dermis than epidermis in the closure. The suture is tied under the minimal tension necessary to appose the skin margins. Because nonabsorbable synthetic monfilament sutures (nylon, Prolene) are minimally reactive, they are preferred for skin closure when cosmesis is essential. Absorbable synthetic braided sutures (Vicryl, Dexon) are ideal for deep dermal closure, acting as transient but necessary skin splints. Absorbable natural sutures (catgut, chromic catgut) induce inflammation as they are degraded by phagocytosis. Still they are useful where suture removal is difficult and cosmesis is not critical (in the mouth, inside the nose, and non-facial wounds in children).

The simple interrupted suture is the most common skin closure method. Horizontal mattress sutures facilitate tissue eversion with the use of 50% fewer sutures. Vertical mattress sutures are useful in wounds under significant tension. Running sutures speed the closure of uncomplicated linear wounds. Subcuticular running sutures yield cosmetically pleasing results in wounds under mild tension.Optimal wound healing and epithelial migration occur in a moist environment free of coagulum or scab interposed between the healing surfaces. Epithelialization takes 2-3 days with air exposure, but only 18-24 hours with occlusion. So a light coat of antibiotic ointment and an occlusive dressing for 24-48 hours is beneficial. Most incisions may be safely cleansed with soap and water after this time. Sutures are removed after 3-5 days in the face and neck, 7-10 days in most other sites, and 10-14 days in the hands and feet. Suture marks are reduced by minimal tension on the skin closure and timely suture removal. In wounds under moderate tension, adhesive tape (Steristrips or paper tape) may be applied for 1-2 weeks to help minimize widening of the scar.

Suture

Updated 3/2017-- all links (except to my own posts) removed as many no longer active.

It's not "Silver Threads and Golden Needles" used to repair a laceration. Nor is it these lovely threads from my sewing room at home. When I was in medical school (having used a needle and thread since age 5 yr) I often slipped and called suture thread. I thought it was an honest miss-speak as we "threaded" those Keith needles. My superiors (residents and staff) did not, and always corrected me. Suture, not thread, is used to repair lacerations.

Suture varies in characteristic---tensile strength, ease of handling, inflammatory response elicited, contribution to infection, knot security, and re sorption (only in absorbables). Suture may be absorbable or nonabsorbable. It may be monofilament or multistrand (twisted or braided together).

Absorbable--biologically derived:
Plain Catgut is derived from sheep or cattle bowel intima. It's has a tensile strength for only 4-5 days, and wound security is almost gone by 2 weeks. It has a moderate-to-high tissue reactivity. It glides poorly through tissue and requires multiple square knots to prevent the knot from unraveling. It is primarily used when tissue healing is rapid and there is minimal tension on the wound or when suture removal will be difficult (children).

Chromic Catgut has good tensile strength for up to 3 weeks. It is more reactive than catgut, so is most often sued for suturing mucosal surfaces (inside the mouth). There its added strength outweighs the increased tissue inflammation, and the scars are not visible.

Absorbable--Synthetic--Monofilament
Monocryl has excellent pliability for easy handling and tying. It is virtually inert in tissue (minimal to none tissue reactivity). It has predictable adsorption. At 1 week, 50% of the initial strength remains; at 2 weeks, 30% remains; and all the original suture strength is lost by 3 weeks. Absorption is essentially complete in approximately 3 months.

PDS (polydioxanone surgical) keeps its tensile strength longer. At 2 weeks, 75% of the initial strength remains; at 4 weeks, 60% remains; and at 6 weeks, 40% remains. Complete absorption occurs in 6 months. As a monofilament, PDS has less tendency to harbor bacteria. It has some intrinsic stiffness and a prolonged memory which some find difficult to handle during surgery.

Absorbable--Synthetic--Multistrand
Vicryl comes in dyes (purple) and un-dyed (white). It is braided. It has a lubricant coating which gives it excellent handling and smooth tie-down qualities. Its tensile strength retention at 2 weeks is 75% and less than 25% at 4 weeks. Complete absorption is between 2 - 3 months. It has low elasticity which predisposes it to cutting through soft pliable tissue if care is not taken ("approximate, don't strangulate"). It is most appropriate for buried intradermal or deep suturing. If placed too close to the surface of a cutaneous wound, Vicryl may be extruded (or spit) before dissolving completely.

Dexon is know for its excellent tensile and knot strengths. Also for delayed absorption and tissue reactivity when compared to catgut. Its tensile strength at 2 weeks is 20% and at 4 weeks on 5%. Complete adsorption occurs after 3-4 months.

Maxon has the excellent tensile strength retention. At 2 weeks its tensile strength is 80%, at 4 weeks 60%, and at 6 weeks 30%. Complete absorption takes place in 6-7 months.

Nonabsorbable--Natural
Silk is made of natural protein filaments spun by the silkworm, usually black (though can be white), and is braided. Possibly the easiest suture to handle (Isn't that true with silk thread too. And silk thread blends in so beautifully when appliquing!). It has the lowest tensile strength of all the sutures mentioned here. Even though it is classified as nonabsorbable, it losses most of its tensile strength in about 1 year and cannot be detected in tissue after 2 years. It results in more tissue reaction than any other suture material except catgut. Because of its increased tendency toward fluid absorption and capillarity, its use is undesirable in areas prone to infection.

Nonabsorbable--Synthetic

Nylon has a high tensile and minimal tissue reactivity. Its prominent memory is its main disadvantage, making it important to throw 3 plus square knots to hold the stitch in place. Although classified as a nonabsorbable, it partially degraded in vivo (in the body). It has only 90% of its tensile strength at 1 year, and only 70% at 2 years.

Prolene/Surgilene (polypropylene) is extremely inert. It expands when stretched (as with wound swelling postoperatively or injury) and helps prevent strangulation of tissue. It is extremely smooth and knot security requires extra throws (square knots) to compensate.

Ethibond/Mersilene (braided polyester) has greater tensile strength than most synthetic nonabsorbale sutures and has improved handling and knot-security qualities.

Wire sutures are stainless steel (so still no silver thread). They are available in monofilament or multistrand, and are seldom used except in sternal (breast bone) closure or tendon repair.

Skin--Healing a Simple Wound/Laceration

Updated 3/2017-- all links (except to my own posts) removed as many no longer active.

All wounds heal through the same orderly process. Consider the simple laceration which is a well-studied wound. There are three phases of wound healing: the inflammatory, fibroblastic, and maturation stages.

The Inflammatory phase begins with the injury/laceration which is the stimulus needed to initiate the cellular and vascular response that serve to clean the wound of devitalized tissue and foreign material. The initial changes are vascular--a transient 5-10 minute period of vasoconstriction (aids hemostasis) followed by active vasodilation. Inflammation begins after injury and peaks at three to five days. The wound site swells as the biochemical ingredients needed for healing gather: leukocytes and monocytes for bacterial phagocytosis (wound cleaning) and lysis, fibrinogen for adherence of wound edges, histamine, prostaglandins, and vasoactive substances for hemostasis. All this must occur to prepare the wound for the succeeding phases of healing. Therefore, drugs which limit inflammation, such as non-steroidal anti-inflammatories or steroids, can slow the healing of a wound.

The Fibroblastic Phase begins on day 2 or 3 with fibroblasts moving into the wound along a framework of fibrin fibers. These fibroblasts begin to proliferate and position themselves for their principal task, collagen synthesis. As collagen content increases, the number of synthesizing fibroblasts begin to decrease until the rates of collagen degradation and synthesis are equivalent (collagen homeostasis). This is the time when the wound site strengthens. Sutures may be removed in three to fourteen days, depending on their location. However, the wound's tensile strength and collagen content increase over the next several weeks; collagen turnover within the wound continues indefinitely.

The Maturation Phase (or remodeling phase) begins approximately 3 weeks after injury and lasts the longest. This phase may continue for several years, with concomitant improvements in wound appearance. During this interval collagen synthesis and degradation are accelerated (no net increase in collagen content), large numbers of new capillaries growing into the wound regress and disappear, and collagen fibers initally deposited in a haphazard fashion gradually become more organized and arranged into a pattern determined by local mechanical forces. The formerly indurated, raised, and pruritic scar becomes a softer, less conspicuous scar, while the wound continues to gain tensile strength. As new collagen is deposited during this phase, more stable and permanent cross-links are established.

The tensile strength of a wound is a measurement of its load capacity per unit area. All wounds gain strength at approximately the same rate during the first 14-21 days, but thereafter the curves may diverge significantly according to the tissue involve. In skin, the peak tensile strength is achieved at approximately 60 days after injury. Even given optimal healing conditions, the tensile strength of a wound never reaches that of the original, leveling off at about 80%.

If more information is desired on wound healing, a very good review is the article "Wound Healing: An Overview" written by George Broughton II, M.D., Jeffrey E. Janis, M.D. and Christopher E. Attinger, M.D., published in the Plastic & Reconstructive Surgery Journal Volume 117, Number 7S, June Supplement 2006.

Skin

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

A recent study by scientists at the National Jewish Medical & Research Center and the University of Colorado Health Sciences Center have discovered that skin cells ward off infection with a protein called human β-defensin-3. This study helps explain why infection of healthy skin cells rarely occurs, even though they are constantly exposed to bacteria. One more reason to be amazed by this amazing organ--skin.

The skin/integument system is the largest organ in the body. It is a tough, resilient barrier that covers the body. It is composed of an outer epidermis, an underlying dermis layer, and the subcutaneous fat layer. The structure of the skin varies considerably from one area of the body to another. The scalp is much thicker than the eyelid skin. The scalp has much more hair (for most of us) than our forearms. Our palms and soles have no hair. The axillary skin has many more sweat glands than the abdominal skin. The skin is commonly affected in systemic diseases. It is also the location of many diseases limited to the skin. It is often damaged by external stimuli such as fire, sunlight, chemicals, allergens, and infectious agents. The skin serves critical functions:  Protection• Thermoregulation• Immunologic Response• Barrier to water loss• Secretion of Wastes• Sensory

Robert Leroy "Lee" Archer, MD

Updated 3/2017-- all links (except to my own posts) removed as many no longer active.

Today my medical school classmate was honored with a "chair"--The Investiture of Robert Leroy "Lee" Archer, MD, the inaugural recipient of the Major and Ruth Nodini Chair in Neurology. Lee (Dr. Archer) is an associate professor in neurology at University of Arkansas for Medical Sciences (UAMS). He was honored with the endowed chair funded by friends, family and patients who want to remain anonymous. He chose the name (the Major and Ruth Nodini Endowed Chair in Multiple Sclerosis and Related Autoimmune Diseases) – to honor the longtime, highly respected El Dorado residents and relatives of his wife, Nancy.

Here is a brief summary of his bio printed in the program:

• Lee was born in El Dorado, AR in 1956. He attended El Dorado Public Schools. He went to the University of Arkansas at Fayetteville on a track scholarship, graduating in 1978 with a BS degree in Natural Sciences. He married Nancy (Huskey) in 1977. He graduated from the UAMS College of Medicine in 1982 (class president), followed by an internship and Neurology Residency at UAMS. He immediately joined the faculty and next year will celebrate 30 years of being on the UAMS campus. He achieved the rank of Associate Professor in 1992. He has received numerous teaching awards from students and humanitarian awards from both students and colleagues. He currently serves as chairman of the University Hospital Ethics Committee.
• He serves the community by organizing international medical mission trips to Honduras through his church, Trinity Presbyterian. He currently serves on the Boards of ARORA, the Pulaski County Medical Exchange, the Pulaski County Medical Society, and the Arkansas Division of the National Multiple Sclerosis Association. He is the immediate past president of the Pulaski County Medical Society and has served on the Board of Directors of the Arkansas Medical Society.
• He developed an interest in multiple sclerosis early in his career after a visit from local representatives of the National M.S. Society. It has continued to be the primary focus of his clinical practice. He approached family and friends, who wish to remain anonymous, with the desire to fund an endowed chair for multiple sclerosis, to further the level of care and research at UAMS. He asked permission to name the chair after Major and Ruth Nodini, who had provided lifelong support and advice to Nancy and to him for over 30 years. Today we (family, friends, teachers, coaches, mentors, nurse, and M.S. advocates) honored him.
  
  

It's Happened Again

Updated 3/2017--  all links (except to my own posts) removed as many no longer active.

A patient calls–My right implant has ruptured. I woke up this morning and now my right breast is smaller than the other. I gently correct her–Your implant has deflated. Saline implants deflate, they don’t rupture.

Patient–Is it going to harm me?/I have a trip planned for this coming week. Me--Your body will simply absorb the IV saline that was used to fill the implant. It isn’t a medical emergency though it can be embarrassing. We can take our time and fit it into your life/work schedule (If patient is pregnant, it can safely wait until the delivery of her baby.) Put a shoulder pad or some other padding in your bra to even it out for now. When would you like to be seen?

Patient–Well what do we have to do? I didn’t realize they would do this. Me–Yes, I reviewed this with you before surgery. All implants fail at some point. Just like anything else man-made.

Patient–So what do we do now. Me--I will need to see you and then call the implant company to arrange the free implant replacement(s). Do you know if you have the "extended warranty"?

Patient–No, I don’t think so. I think my surgery was yyyy. Me–Okay, the extended warranty program didn’t exist prior to October 1, 2000, so you won’t get any other financial help. Just the free implants.

Patient–So what will this cost me? Me–The surgery center will charge you $800, anesthesia’s charge is $500, and my fee is $***(depends on time passed since surgery and whether I was the initial surgeon). This time we will make sure you get the extended warranty (I began paying for it for each patient out of my fee back in 2002 when I realized too many of them were failing to spend the extra $100.)

Patient–I will have to talk to my husband and see if we can afford that. Me–Okay, just let me know when you want to go forward. I will need a minimum of 2-3 days between the office visit and the surgery date (shipping time for the implants and the paper work to facilitate payment, if warranty is in effect). Would you like to schedule an appointment or call back after talking to your husband?

I truly appreciate the patient who remembers the preoperative discussion and who read the information brochure (pdf file). I try very hard to make sure the woman knows that the saline implant is not permanent. Approximately 1% deflate within 1 year, 3% within 3 years, and 10% within 5 years. Because of the warranty set at 10 years, I caution all of them that the mean deflation is 10-12 years (or half at that point). I tell them that it is rare to have a deflation at 1 year, but it can happen. And yes, the implant may last for 20 years, but don’t count on it. I tell them to begin saving money, if they get to 8-9 years without a deflation because they will likely end up out of the extended warranty period.

And all this is said on top of reminding them that this is surgery, the risks of surgery are infection, bleeding, anesthesia/drug reactions, scar, loss of/or decrease nipple sensation. The risks due to the implant include capsular contracture, asymmetry, visible wrinkling of the implant, deflation, repeat surgery to correct any of the before mentioned problems. You will need to be more careful with your mammograms. Four views will need to be done rather than just two. Make sure you go to a facility that is comfortable with implants and do mammograms often on women who have implants.

Flying Geese--a finished project

This is a picture of the finished quilt top from the previous post (Paper Work). It is 51" X 70" and will now be sent to a quilter (part of the QOV group). When finished it will be sent to a wounded (& hopefully recovering) soldier. The pattern is Flying Geese.

Now I will get to start planning another. I will get to go through my quilt books, get my sketch pad out (graph paper), and colored pencils. Then I will get to go through the fabrics I have on hand prior to going off to the fabric store. I had to make myself start doing this last step a few years ago as my "stash" got out of control. Now it is part of the challenge to use what I have and to only add as I need. [Don't always leave the fabric store with just what I went in for.]

Good posture for Sewing (or Blogging)

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

For comfort and to decrease the risk of strain injury, it is important to pick a good chair and to set the sewing machine at a good height for your own body. Susan Delaney Mech, M.D answered this question as follows:

1. The first step is to set the height of your sewing chair. The seat should be at a height that allows your feet to rest flat on the floor and your knees to make a perfect 90-degree angle. A secretarial chair makes a good, adjustable sewing chair.


2. The next step is to lower your sewing machine table until, with your elbows bent at a perfect 90-degree angle, your fingertips can rest on the feed dog of your machine. I am 5 feet 6 inches tall, and my sewing machine table is 22 inches off of the floor.


3. Proper chair and sewing machine height, combined with good posture of your back and neck, and hourly breaks, will go a long way toward preventing (or healing from) Repetitive Strain Injury.

Avoid slouching. Keep your neck and shoulders relaxed. Try to keep your elbow, hips, and knees at right angles (ninety degrees). Avoid pressure to the back of the knees. If your feet can't comfortably be flat on the floor, then consider a foot rest. You should also consider taking breaks every 30-60 minutes and do some stretching exercises for your wrists and hands and body. Sometimes, as in the OR, breaks can't be taken that often. Do the best you can with table/chair (computer moniter/OR table/etc) height and stretch when you are able. It will help keep the aches at bay and the joints a little more supple. That will allow you to enjoy your hobby (sewing, knitting, bloggin) and maybe your work for many more years.

You may want to check out this OSHA sewing station design page. Another interesting source for prevention of injury while sewing/quilting is a powerpoint presentation at Sport & Spine Physical Therapy website is "How to Quilt Forever"

Snake in the Yard

 Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

I found this under my patio table in the backyard yesterday. Yikes! I really don't like snakes, but can deal with them when necessary. Fortunately, my husband was home. So he dealt with the snake (It's a good snake, says he.) while I took the dogs for a walk. It turns out he was right. The snake is a Eastern Hognose Snake (Heterodon platirhinos). In Arkansas, our poisionous snakes include Copperhead / Pigmy Rattlesnake, Cottonmouth, Timber Rattlesnake / Coral Snake, Western Diamondback Rattlesnake. Comparative risks tables place the annual death from drownings at more than 6,000 and the annual deaths from snake bites at 5.5.

There is a very nice review article of snake bites (Bites and Stings: Snake Bites) at Medscape. First Aid in the field (or home) consists of:

1. Preventing systemic absorption of the toxin which may be done with compressive dressings and immobilization of the bitten extremity.


2. If signs of envenomation begin to occur, a constriction band to impede lymphatic flow should be placed on the extremity, proximal to the bite. Transport to a hospital should take place immediately.


3. The site should be wiped off and cleaned. The use of field first-aid methods such as incision and suction, tourniquets, and cryotherapy has been associated with a threefold increase in the likelihood of the need for surgical intervention.


4. Although popular belief has it that snakebites kill within minutes, in fact, the toxicity from snake venom usually does not even begin to affect the body for several hours. In one review, 64% of deaths from snakebite occurred between 6 and 48 hours after the patient was bitten.

I have never in my years of practice had to deal with a snake bite, but have a healthy fear of cotton mouths and copper heads. I know that snakes may be an important part of our environment, but I still don't like snakes.

Have a safe summer enjoying the outdoors!