The Yorkie got loose. Coco snapped her leash and chased after a rabbit into the woods.
Linda Esposito, in her flip-flops, chased after her pet at dusk. That's how the Johns Island resident ended up bit by what might have been a young copperhead snake.
"It felt like a needle in my heel," Esposito said.
Within an hour, the pain was so bad she was panting because she couldn't get her breath.
More than 265 people have been bitten by venomous snakes in South Carolina this year, a record number reported to the Palmetto Poison Center at the University of South Carolina. No one has died, according to the reports.
A peak in the bites occurred at the end of September when at least 24 people in the state were bitten by venomous snakes in a single week, Sept. 27 through Oct. 3. Esposito, who retired to the Charleston area 11 years ago, was among them.
Most of the bites came from copperheads that allegedly came out from hiding to find water during the drought. That's a myth, researchers say.
Hurricane Dorian might have put snakes under debris and the hands of people cleaning up.
The simplest explanation is that when the days and nights cool down, more people and snakes are moving around outside. Most bites happened either along the coast or in the Midlands, where more people, if not snakes, live.
This year is shaping up to be another snakebit year. In comparison, 243 bites were reported for all of 2018, and 198 in 2017.
The 24 bites reported from Sept. 27 through Oct. 3 are among 56 bites for the month of September and 22 reported in October as of Friday.
That's not a surprise for herpetologist Andrew Grosse, with the S.C. Department of Natural Resources.
"Snakes are more active in the spring and fall due to cooler temperatures making it more conducive to moving across the landscape," Grosse said.
They're looking for food and mates, depending on the species, and a place to lay up for the winter.
People, too, are out more, doing everything from gardening to hunting. Those two factors make a meeting more likely, although any number of other conditions could contribute to individual bites, Grosse said.
A basketful of venomous snakes inhabit the Lowcountry: copperheads, cottonmouths and rattlers including the canebrake, pygmy and Eastern diamondback. The deadly Eastern coral snake also is here but is much rarer.
In the swampy, relatively warm Lowcountry, snakes are at home and usually out year-round. They can be chanced upon anywhere. They are ambush predators that lie still in wait, and are "cryptic" — so naturally camouflaged they are difficult to spot.
The venom can have one or both of two kinds of poison. Hemotoxins damage body tissue and blood vessels. Neurotoxins damage the nerves, can cause breathing or swallowing difficulty, and disrupt the heart.
Treating a bite
Dr. Kenneth Perry, the assistant medical director at Trident Medical Center’s emergency department, said treating a snakebite is a bit of a waiting game. When a patient comes in they have to observe symptoms and blood levels to see if the bite was venomous.
If they do find it to be venomous, they administer doses of antivenom until those symptoms dissolve. Wait times for treatment can range from a couple of hours in the emergency department to a week in the intensive care unit.
“This is all dependent on the patient,” he said.
Esposito was kept in ICU overnight at Roper Hospital’s downtown emergency department.
“They were on me constantly,” she said. “So I’m lucky.”
Anyone who is a victim of a snake bite should consult a medical professional, Perry said. Some snakes are nonvenomous. Some venomous snakes will “dry bite,” he said. This means that the bite is more defensive and lacks venom.
But even with those bites there is a chance of tetanus exposure. So patients may need a tetanus booster if it’s been around 10 years since they last got the shot.
Treating a venomous bite is no quick and cheap task. According to Becker’s Hospital Review, the average list price of snake antivenom is over $3,000 per vial. Perry said a single dose of antivenom is around six vials and some patients often need two to three doses.
“So that’s what makes it so difficult and so costly,” he said.
Eposito had to get four vials of antivenom. While she isn’t sure yet how much she will have to pay, she said several people at the hospital were telling her it would probably cost around $200 a vial. She said she didn’t care because she was in so much pain.
“At that point I just wanted to cut my leg off,” she said.
Also while some films depict people removing the venom themselves or trying to block the spread, Perry said this could make things worse and introduce an additional infection.
“The biggest thing is that they should obviously come to the emergency department,” he said.
The drought myth
Most snakes found in the Lowcountry are not venomous, and many of them — particularly water snakes — have markings similar to venomous snakes to discourage predators. Markings can vary widely, even among individual snakes of the same species.
They are considered valuable to ecosystem and species are protected under a numbers of state and federal laws
Snakes do not strike unless threatened, and experts agree the key to avoiding bites is to watch for the reptiles when in the woods or near places they tend to hide, such as under bushes, wood piles or items placed outside.
Copperheads tend to inflict nine of every 10 bites; those snakes are more likely to be found in populated areas.
And for the record, they don't come out farther to drink when it's dry, according to research. The opposite is true: rain that floods their usual spots tends to bring them out. A 2018 study of 20 years of California snake bites found that bite reports dropped off during dry periods. Researchers with the University of Colorado Boulder and Stanford University School of Medicine conducted the study.
Despite the rash of bites, people who spend a lot of time outdoors haven't encountered an unusual number of venomous snakes. Charleston landscaper Jeff Jackson, of the S.C. Native Plant Society, spends his days working in customers' shrubbery, paddling the rivers, studying plants along the beach dunes or in the Francis Marion National Forest wetlands. He doesn't recall seeing a venomous snake at all this year.
"Water snakes, black racers, rat snakes and a green," he said.
Esposito didn't see the snake that bit her, but she was lucky, doctors told her. Once she was given antivenom, her symptoms began to abate. Her foot is still swollen, but it's much better than it was. She expects to start walking again in a few days.