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The Western rattlesnake (Crotalus viridis) is found throughout Colorado at elevations below 9,000 feet and grows up to 3 feet in length. This one was photographed near the Natural Arch in the La Garita Wilderness north of Del Norte, Colorado. (John McEvoy, Special to The Colorado Sun)

DEL NORTE – Each ink line on his orange and purple leg marked the progress of swelling advancing toward his torso from four fang marks near his ankle. At one point, his thigh measured 24 inches around. His waist size is 30 inches. “Pretty gnarly huh?” Tres Binkley asked, only half joking.

Binkley was bitten by a rattlesnake — twice in a fraction of a second — during a trail run on the northeast side of Lookout Mountain in Del Norte just before 5 p.m. on April 25. The first ink marks were made around 40 minutes later, by doctors in the emergency room at Rio Grande Hospital on the other side of the hill.

From the four fang marks in the center of lower inked circle just above his ankle to where the ink marks reach the groin area and disappear up into his shorts, the lines indicate how doctors monitored the swelling and noted the time as it moved ever upward toward Tres Binkley’s torso after he was bitten by a rattlesnake during a trail run near Del Norte, Colorado. (John McEvoy, Special to The Colorado Sun)

He had been running on a ridgeline to maximize his strength training regimen. Binkley occasionally enters races, anywhere from 20K to 50K, but mostly he just loves trail running.

“Moving through terrain efficiently on two feet, two wheels or skis holds my heart. And over the years pushing myself has been part of that,” Binkley said.

He had been watching out for cactus as he moved gingerly over rocks and vegetation going up and down the steep terrain. As Binkley was stepping down over a rock he felt a sharp pain. “At first I thought that’s what the pain was. It took me two or three strides before I could stop. I started to look for cactus spines and realized that it was definitely not cactus. That’s a snake bite.”

He never saw or heard the snake.

“I knew there wasn’t much you could do in the field for a snake bite, except stay calm,” said Binkley. “I didn’t know how much time I had to get help, so I was a little anxious.”

First aid for snake bites recommended by the Rocky Mountain Poison & Drug Center indicates a person should remain calm so as not to increase circulation and spread of the venom and to get to a hospital immediately. Do not apply a tourniquet, or try to suck out the venom as you might have seen in some old movies.

Binkley didn’t have his phone with him, so he ran down the mountain to 11th and Spruce streets, then farther north to a friend’s house. They weren’t home. He ran on, to the Alta Convenience store. In all, he ran less than a mile from where he was bitten to get the help he needed. Still, he said, “I will never leave my phone at home again.”

He saw a U.S. Forest Service worker in his truck parked in the convenience store lot.

“I told him I need to go to the E.R., can you take me?” Binkley said. “First I need to get my phone and my I.D., though.”

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Delays have high-stakes implications

The forest service employee drove him two blocks away to his girlfriend’s place to get his things. She wasn’t home either.

Binkley hadn’t gone into shock yet, but he was starting to feel the effects of the snake bite. “I started to feel this vibration in my hands, in my face, in my teeth, in my – everything.”

He called his mom and his girlfriend as they were on the way to the hospital, a short distance west of town. He also posted to the social fitness network site Strava, to let his followers know what had happened.

Typically, a snake bite victim has an hour, maybe two, to get help before very serious consequences are possible. It had now been about 40 minutes and he had begun to go into shock.

At the hospital, he was given a shot from an EpiPen that is used to treat allergic reactions and hooked up to an IV. He said he was informed that the only way to tell if it was a venomous bite was to monitor the swelling. That’s when the ink markings on his leg began.

Binkley’s memory understandably started to get a little clouded at this point and he was going in and out of consciousness, but he remembers the pain coming in waves and being driven to the Del Norte airport and getting on a plane to Mercy Regional Medical Center in Durango.

“I remember flying and the humor of the EMT’s onboard,” Binkley said. “Everybody was great.”

He was shipped out because the treatment for a snake bite comes with the risk of complications that the local emergency room wasn’t prepared for, Rio Grande Hospital CEO Arlene Harms explained.

“RGH and other San Luis Valley hospitals stock initial emergency doses of anti-venom to administer to emergency-department patients,” Harms said. “However, because rattlesnake bites typically require additional follow-up anti-venom therapy, and both the snake venom and the anti-venom can result in serious and even life-threatening allergic reactions … it is common for small, rural hospitals to transfer snake-bite patients to hospitals with the specialized capabilities to manage such reactions and complications.”

Human snakebite cases are relatively uncommon and fatalities are even more rare. Since 2012, there have been 485 rattlesnake bites reported to the Rocky Mountain Poison & Drug Center, and a single fatality, a 31-year-old triathlete who died after being bitten while hiking in the foothills west of Golden in fall 2017. The number of cases range from a high of 94 last year to a low of 63 in 2014. There have been 10 bites, including Binkley’s, reported so far this year.

Harms said since January 2015, Rio Grande Hospital has treated five venomous snake bites, including Binkley’s injury. Four of the five cases required treatment with anti-venom and were sent to other hospitals. “It is better for the patient to have the experts that deal with it more often than five times a year,” she said.

So-called dry bites, in which venom is not transferred into a patient’s tissue, do not require anti-venom therapy and do not swell nearly as much.

Rio Grande Hospital, which consults on snake bite cases with toxicologists from Rocky Mountain Poison & Drug Center, typically has eight vials of CROFab antivenom on hand. The first dose is four vials. “A full dose during recovery from a snake bite with envenomation can be 16 vials or higher,” Harms said.

Anti-venom is “extremely expensive (our cost — not the patient charge — is around $3,250 a vial) and it does expire in a relatively short time,” Harms said.

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And how big was the snake? Big enough.

Binkley said his doctors in Durango kept in close consultation with toxicology experts remotely.

“Every time they drew blood, they were checking platelets and other things and checking in with the toxicologists every six hours,” Binkley said. The doctors also administered CROFab every six hours. Binkley thinks he was administered five vials.

Doctors were monitoring many conditions. Depending on how much venom patients are exposed to, they can experience a reduced platelet count, or their kidneys can fail. In rare cases, swelling can cut off circulation. And the venom itself is necrotizing. Poison-control toxicologists can help determine when enough anti-venom has been used to neutralize the venom. Then blood tests are reviewed after release from the hospital to make sure the body systems, such as the kidneys, return to normal function.

The doctors also calculated how large the snake was, Binkley said. “They measured the fang marks and came to the conclusion the snake was about 2-feet long.” Not a big snake, but big enough.

According to the CSU Extension, there are 25 species of snakes in Colorado, but the Western rattlesnake (Crotalus viridis) and the massasauga (Sistrurus catenatus) are the only venomous species. The Western rattlesnake appears in most habitats throughout the state below 9,000 feet. The massasauga, however, is limited to the southeastern grasslands.

Binkley said he never really feared for his life during the ordeal because he knew adequate care was available nearby and he wasn’t in a remote area.

“What I was most concerned about was what the complications would be during recovery and am I going to be able to use my leg in the same way,” Binkley said.  “The doctors told me at this point, there should be no long-term muscle damage.”

Tres Binkley keeps his leg elevated during his recovery from a rattlesnake bite. Binkley was visiting his girlfriend in Del Norte, Colorado, when he was bitten while on a trail run. He was supposed to start a new job in Grand Junction on May 2, 2019, but injury has delayed his career transition. (John McEvoy, Special to The Colorado Sun)

Career plans briefly delayed

If not for the snake intervening in his plans, Binkley was scheduled to start a new job as a regional sales manager for Freestone Sales Group, a marketer of outdoor sports equipment in Grand Junction on May 2. His new bosses are willing to work with him and are supportive of his recovery however long it takes. “They are a great group of people,” he said.

He was in Del Norte to visit his girlfriend, Jessica Chacon, who works as a mental health therapist at Alamosa Behavioral Health. Chacon has been instrumental in caring for Binkley during his slow recovery since he was discharged from the hospital in Durango on April 29. Binkley, who lives in Austin, Texas, where he worked as a rep for Patagonia, has visited Del Norte many times.

As often as he runs trails, Binkley said he can’t remember the last time he even thought about being bitten by a snake, or considered what the consequences would be. “It’s way more complicated than I knew, and it really surprised me for sure.”

By May 15, he said he was still experiencing a lot of pain in his leg, but was able to make one full rotation on a bike trainer. “Best feeling in weeks!”

Binkley said he gladly accepts the challenge to slow down and reset before this next chapter in life begins. “It’s definitely been very tough to work through,” he said, “as most good things are.”

Be prepared: Find detailed first aid instructions for treating snake bites at Rocky Mountain Poison and Drug Center:

Special to The Colorado Sun