Who Let The Dogs Out?

It would be an understatement to say that I am a dog lover. I've got a two right now, and they are both in the running for the most spoiled dogs on the planet award. Even though I love them, and love all dogs, the reality is that sometimes they bite. According to the CDC, more than more than 4.5 million people are bitten by dogs each year in the United States.  

I bring this up this week because I saw a patient recently who has been bitten by a dog while out on the trails. 

When we treat patients for dog (and all mammal) bites, there are 4 things to think about:

• How bad is the bite wound? Most simply need irrigation, and closing a wound with sutures can increase the risk of infection. But, if the wound is large, it may need stitches, and if on the face, may need plastic surgery attention.
• Is the patient up to date with tetanus vaccination? If not within 5 years, it should be updated.
• Is there a risk of bacterial infection? Most bites carry a risk of infection from oral bacterial, with cats being particularly problematic, but many patients will need a course of antibiotics to prevent infection.
• Is the animal up to date with its rabies vaccination?

This dog could bite OR sting.

It was that last question that prompted me to think about this article.

There was apparently minimal interaction with the dog's owner and the bite victim, so he had no idea about the dog's vaccination status. He never even got the owner's name. 

I didn't get into the details of whether that was because he (the victim), said "no problem," or if the dog's owner just bolted.

Here's the problem with rabies, it is an incurable and almost universally fatal viral disease. Because of this, we tend to be cautious and always want to know if an animal is vaccinated.

This person had no way of contacting the owner, and didn't know if the dog was up to date, so he bought himself a bunch of shots. Several shots that day, with a vaccine and a dose of immunoglobulin (a protein that is designed to bind to the rabies virus, with much of it injected near the bite). He also needed to come back for another shot 3 days later, 7 days later and then 14 days later. That's a lot of shots that could have been avoided if he had simply confirmed the vaccination status of the dog.

Admittedly, rabies is rare, but again, fatal. Some people may not feel compelled to go through with the series of shots, and philosophically, a lot of it would depend on your level of risk acceptance, but why chance it?

Other animals carry a much higher risk of transmitting rabies, with bats being top of the list. If I had a dollar for every patient I had seen that got rabies shots because they were just in the room with a bat, I'd have a nice lump of money. 

But hey, I think of all the animals that you could encounter on the trails, dogs are probably the most common that might bite you. Certainly, many other woodland mammals could bite you on the trails, but most wild animals are going to be more scared of you and will run and hide when humans are nearby.

Wild animals considered to be "high risk," include bats, as mentioned, along with racoons, skunks, foxes, coyotes, bobcats and woodchucks. 

So, the moral of the story is that if YOU ever get bitten by a dog—whether on the trails or in your neighborhood—be sure to get the owner's information. And if you get bitten by a high risk mammal, unless the animal can be captured and quarantined for 10 days, you're getting the shots. This also applies to stray dogs, cats and ferrets. 

And, I've also taken care of a fair share of patients with human bites, but I'll save that for another article. 

*I do need to stress the fact that the first pic above may look fierce, but that's Gary, the most gentle soul ever playing with Ruby--they loved each other.

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