Rusty is a 6 year old, male, neutered, miniature dachshund. He is current on his vaccines and has always been generally healthy. Two days ago he was presented for back pain. This was presumed to be due to intervertebral disk disease due to the history and physical examination findings with obvious pain in the mid back and very mild neurologic deficits to the hind limbs. He was started on strict rest, pain and anti-inflammatory medications. He is reported to be doing well with treatment and seems comfortable as long as he is at rest. Today he bit Lizzy, the 7 year old daughter, in the hand when she let him out of the kennel and tried to pick him up. (She had been strictly instructed not to do this.) This has never happened before, they are the very best of friends. He is always a happy go lucky fellow who loves everybody. The bite was serious enough to require minor surgery to close the wounds.
What is next for Rusty?
Dog bites are a very serious problem. There are approximately 4.5 million people bitten by dogs every year in the US. Children make up 60% of the victims and 1 in 5 victims will need medical attention. Many children are bitten in the face. Most of the dogs are the family pet.
What happens next with Rusty is largely determined by the family. Even though Rusty is current on his rabies vaccine there are legal and medical protocols that must be followed.
The dog bite is reportable by the medical facility. Law enforcement will give the family a rabies quarantine form that must be completed and returned to the Public Health Officer. Rusty will need to be quarantined for 10 days for observation for symptoms of rabies. Where this can take place is at the discretion of Law Enforcement. Often the quarantine can be conducted at home with specific guidelines.
There are 3 veterinary exams required during the quarantine. The first at the start of the quarantine, the last on the last day of quarantine, and one in the middle. If no symptoms of rabies are seen during those 10 days, Rusty would not have been infectious for rabies at the time of the bite. He can then go back to his normal routine.
The other option for Rusty would be euthanasia. If this is elected, he must have rabies testing. This requires specially stained brain tissue be examined under the microscope.
Rabies is a very serious disease. There have only been a couple of people survive clinical rabies. Estimates range from about 50,000 to 60,000 people die worldwide every year due to rabies viral encephalitis (brain inflammation). Because of diligent dog vaccination in the US, the canine variant of the virus has been eliminated here. However, the raccoon, fox and skunk variants are still very active. We must not let our guard down.
After discussing what happened and the options, the owners elect quarantine. We all agree that Rusty has always been a super sweet dog and that the bite was out of character for him. Furthermore, we all believe that he only bit because his back hurt. The 7 year old can be a bit awkward picking Rusty up. We therefore consider this a provoked bite and think it unlikely to be repeated. Additionally, the risk that this pampered indoor pooch has rabies is very slim.
Day 1: Thursday: Dog bite in the evening. Lizzy taken to hospital for treatment. Included minor surgery and a large bandage. Started pain medications and antibiotics. Spoke with the sheriff deputy and were issued the quarantine order. It was late by the time they got home. Lizzy was exhausted and thankfully went straight to sleep.
Day 2: Friday: First examination. No evidence of rabies on physical examination. Quarantine at home. Lizzy had a tough day at school. Her hand hurt and it was difficult to write with her other hand or even go to the bathroom. She could not play normally either. The bandage change was difficult that night, she had to be held by one parent while the other changed the bandage. The hand was red and swollen around the bite. There was much drama, especially because she could not play with Rusty.
Day 3: Quarantine at home. Lizzy had a better day. The hand was less painful. She was still having trouble playing and could not write because of the bandaged hand. The bandage change went better and there was less swelling. She was still quite upset not to be able to play with her buddy.
Day 4: Quarantine at home. Lizzy had a slightly better day. The hand was less painful. She was still having trouble playing and could not write because of the bandaged hand. The bandage change went better and there was less swelling and redness. The bandage was reduced to a covering wrap. She was still quite upset not to be able to play with her Rusty.
Day 5: Quarantine at home. Lizzy had a good day at school but still could not write. She was still having trouble playing. The bandage change went well that night although it still hurt. She cried over not to be able to play with her buddy that evening.
Day 6: Tuesday: Second Examination. No evidence of rabies on physical examination. His back was much better but far from normal. No neurologic deficits were present. Quarantine at home. Lizzy had a good day at school but still could not write. She was still having trouble playing, she banged her hand on the desk accidentally and made it really hurt. The bandage change did not go quite as well that night. She cried over not to be able to play with or even snuggle with Rusty.
Day 7: Quarantine at home. Lizzy was doing much better. Her hand was much less swollen and she was beginning to be able to hold a pencil again. The bandage was reduced to a couple of band-aids. Mom and Dad were able to distract her this evening.
Day 8: Quarantine at home. Lizzy was doing better yet. Her had was less swollen and she was doing well holding a pencil. Wound care was easy. Mom and Dad were able to distract her this evening with coloring.
Day 9: Quarantine at home. Lizzy was doing well. Her hand was barely swollen and she was doing well holding a pencil. Wound care was easy. Mom and Dad were able to distract her by going to the zoo. She was very upset when she was not allowed to try to touch a shark. The wound still had stitches in place and was to be kept clean and dry.
Day 10: Sunday. No examination possible. Quarantine at home. Lizzy had a good day. She was excited that Rusty was doing well and would be released from quarantine the next day as he was showing no signs of illness.
Day 11: Third rabies quarantine examination. No evidence of rabies on physical examination. Release from rabies quarantine. Return completed quarantine order to the health department as directed. Rusty was still a bit painful on palpation of his back so continued rest was advised for the next 2 weeks. Lizzy went to the doctor to have the sutures removed. The wounds looked very good and she had full use of her hand. She was very upset that removing the sutures would be painful, but happy when she discovered it was not. She was super excited to be able to sit next to and pet Rusty, even if she could not play with him or pick him up.
Days 12 to 33: Rusty was still a bit tender in his back and was kept on cage rest. Lizzy had her first shower in almost 2 weeks (She was not allowed with the stitches in place.) Her scars continued to heal but this process will continue for months.
Day 34: Rusty was deemed to be comfortable and released from exercise restriction.
We are happy to report that Rusty and Lizzy went on to make complete recoveries. She learned her lesson the hard way (as did Mom and Dad) and did not try to pick him up until he was completely back to normal. Rusty is now back to being dressed in doll clothes for their daily tea.
This scenario really helps point out that any dog can bite. Even extremely nice dogs with the appropriate motivation. We must all be careful with dogs and make sure to teach and monitor our children well.