Tuesday, April 4, 2017

On Rabies

April 4, 2017

I was bitten by a dog last Friday morning.  Out for my morning walk, I encountered a dog walker.  I asked if I might greet her charge.  "Certainly," she said, "It'll be fine."

I extended my closed hand and the dog bit it -- hard.  "Did it break the skin?"  "Oh, yeah."

She was deeply chagrined, and explained that the dog was actually her daughter's.  Small comfort, that.  Distracted  by pain and bleeding, I neglected to get contact information and moved on.

After my walk, I washed the bite carefully and applied an over-the-counter antibiotic and bandage.  I hoped for the best.

By Saturday, the best was clearly not happening.  The hand felt hot and was puffy and swollen, so that its normal wrinkly appearance was smooth like an inflated balloon.

In our family, we joke that worrying is the most-distinguishing trait of an Ellis.  As an early therapist told me: "Your family expresses love by expressing worry."  Well, of course! Doesn't everyone's?  Apparently not.

Through social media, my wife and son quickly learned of the encounter and bade me "Get thee to a physician!"  Saturday night the pain was enough to make sleeping difficult, so I knew they were right.

On Monday, having researched both local doctors and hospitals near Bandon, I drove 20 miles or so to Coquille Valley Hospital .  I had considered just going to a family practitioner in Bandon, but wasn't sure how to choose one. Too, I wanted to be seen by someone experienced in the field.

The clerk, nurses and doctor at the Emergency Department couldn't have been nicer or quicker.  They listened carefully to what I said, treated me with respect, and got me on my way in under an hour with a prescription for Augmentin .  The doctor cautioned me, though, that the 20 capsules "might not be cheap."

Gritting my teeth, I returned to Bandon's CVS Pharmacy, where the prescription cost...$3.25.  I'll never understand drug pricing, I guess.

Today (Tuesday), I'm on the mend.  My hand is less-inflamed and cooler, if still a bit swollen.

So...lesson learned, right?  Don't try to greet strange dogs even if their handler says it'll be OK.  Move along. Nothing to see here.

Except...what if the dog was rabid?  (Antibiotics, like Augmentin, are useless against Rabies, because it's a virus.)

I had discussed it with Doctor Pasternak.  (I decided not to ask "Isn't your name supposed to be "Zhivago?" figuring he'd heard that joke before). He explained that no cases of rabies in a human contracted from a dog had happened in Oregon for, well, a long time.  The statistics bear him out: Of 621 dogs tested for Rabies since 2000, zero were infected.  (On the other hand, 8.4% of bats tested were positive.)

He told me that rabies vaccinations were "not indicated" in my case.  I remembered horror stories about rabies vaccine, which, at one time, involved, if I recall correctly, a regime of 14 shots into the abdomen.  Nowadays, administration is much more routine, though it's still expensive, around $700.

"But," I quavered, "What if I don't get the shots and become symptomatic?"

"You die!" he answered cheerfully.

Indeed, Rabies is usually described as "Invariably Fatal," a phrase that it is distinctly uncongenial when applied to oneself.  There was hope for the Milkwaukee Protocol for a time, but it's been largely disproven.

I won't be getting the immunization, because, statistically, it's not called for.  But it's not the first time that I've felt as if statistics do not sound completely convincing when applied to me as an individual.  For example, I got a full course of "adjuvant" radiation therapy for my prostate cancer, even though surgery alone would have been enough, statistically speaking.

The takeaway, as journos call it:  Be very cautious to avoid contact with wild animals, especially bats and foxes.  (Note that, while dogs are not a significant vector in the U.S., they are in many foreign countries, including in Mexico).  Here in the Pacific Northwest, bats are, by far, the commonest vectors.  Avoid touching them.  If you think you may be exposed, see a doctor.  If bitten by a pet, be sure to get contact info so the animal's vaccination record can be traced.

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