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January 6, 2008
Cured of a Fatal Disease
Considering myself a Dr. Doolittle of sorts, always talking to the animals, I reached out to pet a feral cat sitting quietly outside our barn one evening a month ago while doing barn chores. This is a grayish fluffy cat I see around the barns every few months or so--he doesn't put in frequent appearances and reminds me of a kitten we raised on this farm a few years back, though his markings are a bit different, so I know it is not our cat.
We have 6 cats to pet here who claim "us" as their home and family, so there is no lack of fur balls to love. There are probably that many more who hang out now and then considering our farm fair game and looking for an occasional free meal. This cat just seemed to need a reassuring pat at that moment or maybe I needed the reassurance. Wrong.
I found myself with a cat attached to my wrist by teeth and claws. It took a bit of an effort to shake him off and he escaped into the night. I then surveyed the damage he inflicted and immediately went to wash my wounds. They were deep punctures near my wrist joint--not good. Lucky for me I was up to date on my tetanus booster.
By the next day the wounds were getting inflamed and quite sore. I know all too well the propensity of cat bites to get badly infected with Pasteurella Multocida, a bad actor bacteria that can penetrate deep tissues and bone if not treated with aggressive antibiotics. After getting 6 opinions from my colleagues at clinic, all of whom stood solemnly shaking their heads at my 12 hour delay in getting medical attention, I surrendered and called my doctor's office. I pleaded for a "no visit" prescription as I was up to my eyeballs in my own patients, and he obliged me. I picked up the antibiotic prescription during a break, sat in the car ready to swallow the first one and then decided to wait a little longer before starting them, knowing they wallop the gut bacteria and cause pretty nasty side effects. I wanted to see if my own immune system might just be sufficient.
So the bacterial infection risk was significant and real but I was prepared to deal with it. For some reason I didn't really think about the risk of rabies until the middle of the night when all dark and depressing thoughts seem to come real to me.
I don't know this cat. I doubt he has an owner and it is highly unlikely he is rabies vaccinated. My own cats aren't rabies vaccinated (and neither am I) though if I was a conscientious owner, they would be. Yes, we have bats in our barns and woods and no, there has not been a rabid bat reported in our area in some time.
But what if this cat were potentially infected with the rabies virus but not yet showing symptoms? Now my mind started to work overtime as any good neurotic will do.
The cat was gone--there was no finding him in the vast woods and farmland surrounding us. He couldn't be kept in observation for 10 days and watched for symptoms, nor could he be sacrificed to examine his neural tissue for signs of the virus.
I called the health department to ask what their recommendation was in a case like this. Do they recommend rabies immune globulin injection which should have been done as soon as possible after the bite? I talked with a nurse who read from a prepared script for neurotic people like me. Feral cats in our area have not been reported to have rabies nor have skunks or raccoons. Only local bats have been reported to have rabies but not recently. This cat would have had to have been bitten by a rabid bat to be rabid. This was considered a "provoked" attack as I had reached out to pet the cat. This was not a cat acting unusually other than having wrapped itself around my arm. No, the Health Dept would not recommend rabies immune globulin in this situation but I was free to contact my own doctor to have it done at my own expense if I wished to have the series of 5 vaccination shots over the next month at a cost of about $3000. Yes, there would be a degree of uncertainty about this and I'd have to live with that uncertainty but she reassured me this was considered a very low risk incident.
I knew this was exactly what I would be told and I would have counseled any patient with the same words. Somehow it is always more personal when the risk of being wrong has such dire consequences. I could see the headlines "Local Doctor Dies From Rabid Cat Bite". This is not how I want to be remembered.
Rabies is one of the worst possible ways to die. The cases I've read about are among the most frightening I've ever seen in the medical literature. Not only is it painful and horrific but it puts family and care providers at risk as well. It also has an unpredictable incubation period of a up to a month or two, even being reported as long as a year after an exposure. What a long time to wait in uncertainty. It also has a prodrome of several days of very nonspecific symptoms of headache, fever and general malaise, like any other viral infection before the encephalitis and other bad stuff hits. I was going to think about it any time I had a little headache or chill. This was assuredly going to be a real test of my dubious ability to stifle my tendency for 4-dimensional worries.
I decided to live with the low risk uncertainty and forego the vaccination series. It was a pragmatic decision based on the odds. My wounds slowly healed without needing antibiotics. For ten days I watched for my attacker cat whenever I went to the barn, but he didn't put in an appearance. I put out extra food and hoped to lure him in. It would have been just be so nice to see his healthy face and not have to think about this gray cloud hanging over me for the next few months, as I wondered about every stray symptom. No gray kitty to be seen.
Almost a month has gone by now and he finally showed up the other night. I could have grabbed him and hugged him but I know better now. No more Dr. Doolittle.
He is perfectly fine and now so am I, cured of a terminal case of worry which is not nearly as deadly as rabies but can be debilitating and life shortening none the less. You'd think I'd eventually learn...