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RE: What's up with Crofab use?
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by CharlieO on September 14, 2011
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One of the things resonating in this thread is the implication that the doctors treating the bites in question were a) incompetent, b) neglectful, c) dishonest or d) some combination of all of the above.
While I am sure there are people in all professions who fit one or more of these categories, the information provided in this thread is neither complete nor compelling.
The treatment prescribed in the cited cases may or may not have been appropriate in those cases; no reliable, objective evidence has been presented to lead to any conclusion one way or another.
If the concern is that proper treatment is not being provided, then present something clear and objective that indicates a proper protocol for a given situation. If one has evidence of inappropriate treatment, contact someone who has the ability to do something (either educationally or punitively) to correct the situation. Without evidence, accusations such as those made here do nothing to improve the situation; they only mar reputations without foundation. Most people want to do the right thing; what they do may or may not be ideal (or even correct) in every case; regardless they don't simply deserve condemnation just because someone thinks they were wrong.
Sorry for the rant; I just think it's wrong to cast aspersions without concrete evidence to do so.
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RE: What's up with Crofab use?
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by bwanadon on September 14, 2011
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No conclusions were drawn and it should always be acceptable to raise questions. Occasionally that's how we get answers.
Personally I remain skeptical of most use of CroFab on most Copperhead bites and 18 vials for a juvenile bite especially so. It might also be pointed out that CroFab is produced using only Rattlesnake and Moccasin venoms...not Copperhead venom and that may account for a lower response rate for copperhead bites which could be why so much was used.
Mocassin venom is not the same as Copperhead venom and is capable of killing other snakes including other Moccasins.
One other aside, the Southern subspecies of Copperheads has venom which contains a statin which has shown significant promise in cancer treatment and especially breast cancer.
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RE: What's up with Crofab use?
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by agkistrodude on September 14, 2011
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bwanadon, (since you haven't filled out your profile, therefore nobody knows who you are)The Dr in charge of my horridus bite was very familiar with snake bite protocol.In fact he had previously worked several snake bite cases with the founder and webmaster of this website. You need to fill in your profile. Take care, Marty
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RE: What's up with Crofab use?
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by bwanadon on September 14, 2011
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You were fortunate to have a physician knowledgeable in treating snake bites. Since venomous snake bites are a relative rarity most doctors are in the dark regarding treatment. Additionally, not many facilities carry much CroFab because of the rarity of bites and the cost to stock it.
From your description of the treatment it would seem you took a pretty hefty hit.
BTW the initial story regarding the Diamondback bite being treated with 4 CroFab vials was incorrect. The total was 12 vials and the cost per vial then was $2,000. That was Spring 2008 so the cost has probably risen since then.
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RE: What's up with Crofab use?
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by CanadianSnakeMan on September 15, 2011
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I have to agree with CharlieO. Without seeing the patients' lab work (or lack thereof) for signs of systemic envenomation and the subsequent response to AV, it is unfair to hint at some sort of negligence or malpractice on the part of the attending physician.
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RE: What's up with Crofab use?
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by bwanadon on September 15, 2011
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Is it OK if I wonder about it? Seems to me that's my prerogative. It also seems that you are willing to take it on faith without the supporting evidence.
I never said it was negligence, but I do have questions about CroFab use on Copperhead bites given that CroFab is made without Copperhead venom and contortrix venom is different from piscivorus venom. There is also considerable expense involved in any hospital stay. Total bill for the Diamondback example cited (4 days 12 vials) was $96,000 in 2008. Maybe that sort of response isn't warranted for Copperheads.
Here is a good example of a medical group that doesn't think anti-venom treatment is warranted for Copperhead bites...
http://www.sciencedirect.com/science/article/pii/S107275151100007X
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RE: What's up with Crofab use?
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by bwanadon on September 15, 2011
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Is it OK if I wonder about it? Seems to me that's my prerogative. It also seems that you are willing to take it on faith without the supporting evidence.
I never said it was negligence, but I do have questions about CroFab use on Copperhead bites given that CroFab is made without Copperhead venom and contortrix venom is different from piscivorus venom. There is also considerable expense involved in any hospital stay. Total bill for the Diamondback example cited (4 days 12 vials) was $96,000 in 2008. Maybe that sort of response isn't warranted for Copperheads.
Here is a good example of a medical group that doesn't think anti-venom treatment is warranted for Copperhead bites...
http://www.sciencedirect.com/science/article/pii/S107275151100007X
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RE: What's up with Crofab use?
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by AquaHerp on September 16, 2011
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Funny how people tend to underestimate how serious a copperhead bite can be. Is it as bad as an Eastern diamondback bite? Could be. As was pointed out earlier, each envenomation is its own case. Doctors will follow the advice of the AV insert, many times in conjunction with advice from a poison control professional. If symptoms are not subsiding, more will be given. If lab results call for more, they get more. If things stabilize......they may get more later, if needed. CroFab does exit the body quickly and deep tissue envenomations are tough to treat with this product. Recurrance is not at all uncommon with this. I nearly lost a thumb after a physician decided to stop AV treatments and sed me home. During the night, recurrance kicked in and it was almost worse than the initial round. It took 10 more vials after that to get a handle on it.
The moral of the story is, one never knows how much it will take to treat a bite, there is no "standard". CroFab may in fact neutralize an EDB bite better than some subspecies of the copperhead.
Hospitals usually set prices on thier inventory based upon the supply and demand as with any business. It's usually a set formula. Hospitals not using AV on a regular basis most likely charge a higher fee.
A great quote comes from Dr. Leslie Boyer who did initial and followup tests on CroFab. "People often ask me... Did you know in Africa that treatment with antivenom can cost more than a person's annual salary"? "Guess what, it does here too" she answered.
DH
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RE: What's up with Crofab use?
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by Agkistrodoncomplex on September 16, 2011
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An A.pictigaster dropped my blood pressure to around 70/30 in less than 30 minutes after the bite. I didnt refuse the 6 vials of Crofab.
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