Saturday, November 5, 2011

Rabies. Learning My Lesson The Hard Way.

All of us have to learn some lessons the hard way every once in a while. 

I have to remind my clients that I don’t want them to make the same mistakes that I have.

There are even occasions that I find myself  begging them to heed my warnings as the lessons learned have dire consequences.
I don’t get much resistance from clients about vaccinating for rabies. Primarily because it is required by Federal and Maryland state law that every pet be vaccinated. But, every once in a while I find myself in an exam room with a client actually having the following discussion. Like, the “law” is something I can give your pet a “pass” on.  

I think that people want to believe that their pet is immune to disease. I also think that some people are plain old tight wads. With either excuse they are placing not only their pets health and safety, but also their families own health, and life, on the line. 

How is it so difficult to understand that we vaccinate your kids, yourself, and your pets to try to reduce all of their chances of contracting a disease? Maybe we are all too far removed from the days of polio? Maybe we have forgotten how many millions of people have died from diseases that are almost considered eradicated now?
I have had to learn my lesson the hard way that rabies is NOT one of those mysterious, “heard of, but never seen it, because it doesn't really exist around here,” kind of diseases. Let me say loud and clear that "rabies is alive and well in all areas of the continental Unites States." 
My first experience with rabies began my first year out of vet school. I went into a routine new kitten examination to meet a little 1-1/4 pound (about 5 to 6 weeks old) sweet orange ball of fur and fluff in a brand new Couture pink sparkly bedazzled pet carrier. This little kitten was much more interested in exploring her new world than looking fashionable, but her barely minted proud new mom wanted a transportation device that had style. It was like carrying a WWF wrestler to the fighting ring in Cinderella’s  glass coach. That young college -aged girl who was very much the epitome of modern trendy elegance, wanted a cute pet she could accessorize to match her own stylish outfits. But contrary to just looking en vogue this little kitten had an endless amount of firecracker energy and an all-over the place personality. I was delighted to see them. Even if that kittens mom refused to give up on her attempts to domesticate her new little beast she loved that kitten and I was sure there was a long term bond here, individual personality clashes aside. 

That first exam on her kitten “Sunny” was uneventful. We tested her for FeLV/FIV, (both were negative), de-wormed her, and reviewed the protocols for vaccinating. I explained to her that  we typically begin vaccines at 8 weeks old, and repeat them every 3 weeks until 16 weeks. We also vaccinate for rabies at 12 to 16 weeks. We made an appointment for Sunny to come back in two weeks to start her kitten shots.
A week went by and I received an urgent phone call from Sunny’s mom that she wasn't eating well. I asked her to bring her in immediately. When she arrived Sunny was still a bright bubbly effervescent kitten. She was however underweight. I often have difficulty understanding  what a client is trying to explain to me, whether it be language barriers, social or cultural differences, or because clients don’t always tell you the truth, the whole truth, and nothing but the truth, so often I have to try to weave an owners description with my own observations. I have to try to investigate why something is happening, especially important because my patients can't tell me themselves. 

For instance, I have seen pets not eat because another pet in the household is eating their food before they can get to it, or, they are feeding a food that the pet doesn't like, or cannot eat. About 10 years ago the pet food companies actually had to change the shape of some cat food kibble because smooshy faced kitties couldn't pick up the pieces to get the food in to their mouth. If I am feeling stumped about a case, or if something doesn't make sense to me I try to do my own investigative digging. For Sunny I did what I have done multiple times before, (and hence made my first BIG mistake), I asked Sunny’s owner to leave Sunny with us for a few  days for us to observe her. I wanted to know if she was interested in food, but wasn't trying to eat? Or, was she eating but not keeping it down? etc. etc.
I brought Sunny back to the hospital and asked the entire staff to keep a close eye on her. Within a few hours she was playing up front with the receptionists and seemed happy, playful and fine. It took the next day for me to start to see that she was in fact acting a little oddly. She didn't have coordinated concise movements. She was clumsy and also started to tremor a little. I then got my big “light bulb” moment and thought about the worst case scenario, (which I have learned I need to think of first with every case). I scooped her up, brought her upstairs, and placed her in quarantine. I also called Sunny’s owner to update her. Unfortunately, I didn't have much good news. Instead of giving her answers I was giving her more questions and I didn't have any idea when I would know any of the answers.
After two days Sunny could barely walk. She was barely functional at all. Her prognosis was grave. I called her mom and asked her to come in and see her. When she arrived all she could do was cry. Her once perfectly animated kitten had turned into a lifeless pathetic shell. I told her that she should be humanely euthanized before she died from respiratory arrest which I thought would happen within the next 24 hours. 

Unfortunately, Sunny had bitten and scratched not only Sunny’s mom, but her granddad, and one of my receptionists. I now had to send Sunny to the state pathologist to have her examined for rabies. She tearfully said her goodbye and we all tearfully euthanized her.
A few days later we received the call from the state lab that Sunny was indeed positive for rabies. My heart sank. I felt awful that so many people now had to go to their doctors and receive post rabies exposure shots. From that day on I have made sure that everyone who works at Jarrettsville Vet is vaccinated for pre-exposure rabies. Thankfully everyone in Sunny's family was fine. And I have learned my lesson. I will always think of “worst case scenario” first, and I will not put my staff at risk.
Every year JAVMA (Journal of the American Veterinary Medical Association) publishes a “Public Veterinary Medicine: Public Health” report on the “Rabies surveillance in the United States.” The September 15, 2011 edition reported the following, “during 2010, 48 states and Puerto Rico reported 6,154 rabid animals and 2 human rabies cases to the CDC, representing a 8% decrease from the 6,690 and 4 human cases in 2009. Hawaii and Mississippi did not report any laboratory-confirmed rabid animals during 2010. Approximately 92% of the reported rabid cases were wildlife.” 36% were raccoon's, 24% were skunks, 23% were bats, 7% were foxes, 5% were cats, 1% were cattle, and 1% were dogs.
I think the whole article is really worth reading.

And as an end note; the two human fatalities were; a 19 yr old migrant worker from Mexico who entered the US on July 25, 2010, and on Aug 2 reported left arm and shoulder pain. His clinical signs progressed quickly to generalized weakness and he had to be intubated to maintain breathing. He died on Aug 21, 2010. His rabies was tracked back to being bitten by a vampire bat on July 15 in Mexico. The second human fatality was a 70-year-old man who began to experience right shoulder pain on December 24. Two days later he began to have difficulty swallowing. Four days later he had to be intubated. It is unknown how he contracted rabies.

If you have any pet related questions you can find me at Pawbly or in person at the clinic Jarrettsville Vet.

1 comment:

  1. I think this is one of the vaccines where the question isn't really whether to vaccinate, but how often.

    Studies are being done to assess how long and immunity from the rabies vaccine lasts. Which I think is great.

    Up here we have the 3 years vaccination; I am hoping for longer period yet.