Friday, January 26, 2007


Continuing an occasional series.

As someone who has lived only in Australia and the UK, it is fascinating, and frightening, to see the prevalence elsewhere of rabies, which those of us in Oz do not encounter. Apart from the odd bat lyssavirus in North Queensland, that is.

Dr Dork last exposed himself to the possibility of this nasty disease when in Indonesia a few months prior to the Bali Bombings.

Dr Dork strayed from the usual tourist path to a fair degree, and thus was taking appropriate malarial precautions. With associated amusing dermatological effects.

Dr and Mrs Dork visited a tourist site replete with a surfeit of semi-tame monkeys. These little guys were quite used to tourists, in no predatory danger, and would probably dance upon your outstretched palm if they thought there was a banana in it for them.

When you entered this park, you could purchase a bunch or two of (rather meagre) bananas, all the better to feed the unrestrained zoo within.

Dr Dork, like your stereotypical Western tourist, was wearing a shoulder bag containing photographic paraphernalia. Mrs Dork decided to store a few spare bananas in the shoulder bag.

Dr Dork was not aware of this at the time.

He was rather perturbed, in due course, to find himself surrounded by a collection of very demanding little simians. And their many, many teeth.

And a bite from such is rabies until proven otherwise.

Thus the benefit of vaccination, especially in one whom anything with teeth tends to find...teethable. Tasty. Worth a 'chomp' or two.

A bite, where rabies is prevalent, is rabies until proven otherwise, as far as Dr Dork is concerned.

Rabies is preventable. It is treatable.

If not treated, it is fatal.

More bl***y needles...


Dr. Deb said...

I'm needle phobic too. But more illness phobic than anything else, so the needle would win hands down.

Dr Scott said...

A patient of mine actually died from rabies last year. Source was never identified, but was thought to be a bat in the rafters of the family's house. Truly frightening.

Bardiac said...

When I saw the picture of the dog (wolf?), I thought you were going to post about depression again. Weirdly, rabies vaccines seem easier/better.

dragonflyfilly said...

i've heard that the treatment for rabies is extremely unpleasant...(?)

SeaSpray said...

Hi Dr. Dork - I had the rabies series given to me back in October 1999.

That summer we had a lot of patients that came into the ED for the rabies series. Some had bat bites but most were for possible exposure. They say that if you find out a bat was in your house while you were sleeping that even though there isn't any evidence of a bat bite, that it is still possible you were bitten and you wouldn't know because the puncture would be so small and that everyone in the house would have to get the series.

One man I registered had a bat bite on his hand. He had reached into some kind of shelving and a bat flew out. When he removed his hand he had 2 tiny puncture wounds with one puncture slightly torn.

We had a lady come in who had to get the rabies vaccine because of possible rabies exposure. A bat flew out when she opened her patio umbrella. It didn't touch her in anyway but it flew close to her. If I remember correctly they were concerned about the disease being air born.

Remembering what his bite looked like and the fact that a bat was under a patio umbrella is what prompted me to get the series. I had left big dark bath mats on the clothes line for the entire weekend (was busy working)and that following Monday I removed the rugs from the line and draped them over my forearm. I put the rugs down when I got inside and immediately noticed these 2 tiny symmetrical puncture wounds that looked almost the same as what the pt had when he was bitten by a bat.

We do have bats around our neighborhood and they definitely hover over the pond and our pool at nite going for insects. It is possible one could've been nesting in the big dark rug. I don't know if it is likely and so it took me 4 days before I decided I should get the rabies series. I tortured myself reading info on the net. some of my co-workers thought I shouldn't and others thought I should.

The deciding factor for me was that rabies is a hideously painful way to die and the puncture wounds did look like a bat bite. I have wondered if a spider could've done the same thing?

The funny thing about this (not to my friends)is that I decided suddenly while we were going out of state for the weekend that we had to stop at the local hospital first so I could get the shots.

Since they give the first shot (which is a tough one and I didn't make a sound) at the site of the bite, my shot was given to me between the thumb and index finger.

Two states later while driving on some major highway in the dark, I noticed that my hand and forearm were swelling significantly. None of us said anything about it, but we were all concerned that I might be having an anaphylactic rxn and we were in the middle of nowhere.

By the time we got to our destination I was feeling feverish and achy, which continued through the weekend.

7 and 1/2 years later and I still have residual swelling in the hand and forearm. It has gone down but not all the way.

Did I make the right call? Did I over react? I guess I will never know, but with possible rabies exposure - I would rather err on the side of caution.

The cost of that first shot along with the tetanus shot was 5,000.00! The subsequent shots were less. I called our hospital billing dept. chuckling, saying I knew this was a mistake. It wasn't! Thank God for insurance.

Dr Dork said...

Hi Deb,
I'm not too phobic, just a wuss. And slothful, of course, and rabies requires three shots over a month.

Hi Dr Scott,
Sorry to hear that. My understanding is that once features of rabies develop the survival rate is basically zilch even with optimal Rx.

Ha ! Are you calling me a broekn record ?

Ha ! Are you calling me a broekn record ?

Ha ! Are you calling me a broekn record ?

Ha ! Are you calling me a broekn record ?

Ha ! Are you calling me a broekn record ?

Ok, not funny after about the third one. Sorry. Seriously, I like dogs. That don't bite me.

I'm far from an expert on the topic. As far as I know the treatment after suspected exposure (ie. a bite from bat, dog, foaming squirrel) is mainly more vaccine boosters and rabies immunoglobulin (ie. antibody injections) - these are both pretty benign. If you develop the disease rabies, as I've noted above, it is effectively a death sentence, and one is very, very ill. At that stage the treatment is just "trying to keep patient alive", it seems.

Hi Seaspray.
Bats give me the creeps. It seems odd that you reacted so strongly to the booster but not to the original series. Could have been some weird spider or something, who knows? In your shoes, I would have done the same - if any rats or bats look at me funny I'd think about treatment! Ha!
And 5 grand! Bloody hell! The vaccinations (pre or post exposure) are about 100 bucks a shot here in Oz, the immunoglobulin is expensive but is fully govt. subsidised.

My skin is still crawling even thinnking about bats. Urgh.

Kind regards

Bardiac said...

Hah, you cracked me up. It's just that the usual lab dog pictures you put up seem so friendly and all, while that recent one doesn't seem quite so friendly, and thus more fitting.

I love bats. They're so utterly different and beautiful in their way. And soft.

SeaSpray said...

Hi Dr. Dork - The initial bite presented as 2 tiny, symmetrical puncture wounds. One puncture was ever so slightly raised around the puncture and the other was flat. I could see blood in the punctures but they weren't actively bleeding. They did look exactly like the puncture the pt with the bat bite had - minus the tear - which he probably got because the bat bit him while flying out of the space.

The punctures slowly faded into tiny scars that eventually faded away. My hand and forearm didn't swell until after I got the first injection.

I thought the first injection is the major dose and is why it hurts SO MUCH and is why I swelled after the first one. I also got the tetanus shot that was in the other arm and I never react to that.

The patients getting the series have to come back 4 more times spaced over a certain number of days for the follow up injections but they don't hurt at all like the first one.

One patient told me that you can tell if bats are around if you see brown streaks on your house, car, etc. because they are hovering in that area eating insects. That was the other part of the criteria that caused me to opt for the rabies vaccine. I recalled that I had seen their droppings on our outside doors and on our cars. Both areas have lites on that would draw the insect that draw the bats.

Evidently, at one time it wasn't as prevalent in my area. I live in northern NJ and back in the late 80s or early 90s (don't remember now) the person in charge of infection control said the CDC was tracking the progression of rabies from the southern part of the country to the north and they had determined that it was one county away from us.

I had always assumed rabies was everywhere.

Also, some medical staff think it is overkill the way the vaccine is given out. They personally wouldn't do it just because a bat flies close to a person. Really, I have to say that using that as one of the criteria does seem a bit much because, seriously - there are many times bats swoop down around people in pursuit of their food. I have seen that since I was a little girl.

One last thing - aside from the obvious of the necessity to have our pets vaccinated it is also a good argument for not letting them run loose. Many times entire families would have to come in for the series because there was a "possibility" that there pet was exposed to a rabid animal and the animal's saliva "could be" on their fur/coat.

jmb said...

Many years ago, a patient presented with the disease in the ER of the hospital, where I worked in Pharmacy. He was only 25 and had been bitten by a bat while treeplanting in the backwoods, two weeks or so previously, and had ignored it. After three months in intensive care, with every effort being made, and after all his family and friends came in to see him, his life support was disconnected and he was allowed to die. It was the saddest thing and so unnecessary.

As I recall, they even tried a series of interferon injections, which were extremely experimental at the time.

Fallen Angels said...

I love the wolf much so that I have the exact same print hanging in my office above my desk! I am very partial to wolves.

The rabies map is very interesting. Rabies is present in ALL of North America?!? Did not know that. Of course we hear the occasional story of someone being bitten and not being able to find the animal, therefore needing to go through the series; or occasionally an animal appearing somewhere that is acting "strangely" and animal control is called to deal with the animal. But these stories are few and far between. In 10 years of billing/coding for primary care, I didn't come across even one person with a (possible or otherwise)rabies exposure. Maybe when I progress to the clinical stages of nursing school I will hear more of these stories.


SeaSpray said...

Seriously F.A.?

Our contractor has said he has been around so many bats that fly out of rafters (he's a builder)and that he never worries about it.

We have many patients in our area that have come in for the rabies series (mostly for possible exposure)- usually referred by their PMD's. Spring, summer and fall, but mosly summer.

Bo... said...

That's a scary pic!

Dr Dork said...

All this talk about bats is creeping me out.


Soft ? SOFT !?!

Oh dear. Excuse me while I go and hyperventilate.

Such interesting (and sad)tales. I doubt if most of my colleagues here in Oz have ever seen a single case.

Fallen angels, doesn't that frighten visitors to your office a tad ?


I'm too scared to go to North America ever again, all these bats massing on the power lines in Hitchcockian droves...

Kind regards

SeaSpray said...

'all these bats massing on the power lines in Hitchcockian droves" - That's really funny Dr Dork! :)

jmb said...

Well, Dr Dork, we might have the bats, but where I live, in Vancouver, I don't miss the venomous snakes, or the poisonous spiders, which were the big worry of my Australian youth. When I go camping, I only have to worry about the bears and the cougars!
All the best

Dr Dork said...

Hi jmb,

Well, yes, there are a few dozen things that can kill you in the average square metre here, of course.

Strangely, snakes, spiders don't bother me at all.

Perhaps it's about the wings.

Or reading Bram Stoker too often.

Kind regards

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