Posted on 01/09/2019 9:56:44 AM PST by Gamecock
A 65-year-old woman from Virginia died after being bitten by a dog while on a yoga retreat in Asia. According to a new case report from the CDC, the woman spent seven weeks touring India, and at one point was bitten on the right hand by a puppy, which exposed her to rabies. The woman cleaned the wound herself and thought nothing of it.
After returning home, she began to feel pain in her right arm over a month later. She waited three days before deciding to go to urgent care, where medical professionals misdiagnosed her with carpal tunnel syndrome and sent her home with anti-inflammatory meds. A few days later, she checked into the hospital with symptoms including anxiety, shortness of breath, insomnia, and trouble swallowing. This time doctors misdiagnosed her with a panic attack.
The woman was given anxiety medication and hardly made it out of the parking lot before returning to the emergency room claiming shortness of breath and claustrophobia. She was reassured that it was a panic attack.
The next day, continued pain in her arm and shoulder, shortness of breath, anxiety, and increasing paresthesia (think: pins and needles pain, numbness, and burning sensation of the skin) had the woman heading to a different hospital, this time by way of ambulance.
Lab work and exams were conducted, and the patient showed that she was losing control of her bodily functions. Blood wasn't flowing properly to her heart, and she had unusual chest pain, but a procedure that evaluates the heart for damage, muscle function, and blocked arteries didn't find anything abnormal.
The woman became more and more agitated and combative that evening and was reported to be gasping for air when she tried to drink water, leading the hospital staff to ask the woman's husband about possible animal exposure. He let the doctors know that she had been bitten by a dog on her overseas trip.
The following day—six days after her initial visit to urgent care—her health quickly deteriorated. She showed signs of severe brain inflammation and was placed on a ventilator. The woman was officially diagnosed with rabies and over the next 10 days, doctors aggressively tried to save her life. She was eventually put into a medically induced coma, and after those 10 days, the woman's family opted to stop treatment and she died.
Sadly, there have been no reports that the woman took action to protect herself before her travels, nor did she ever receive a rabies vaccination in her lifetime. If you are planning a trip abroad, it's important to prepare yourself by undergoing a health screening and receiving the appropriate vaccinations for your international travels, which may include a rabies vaccine.
While rabies infections are quite rare in the U.S. (only 23 cases have been reported since 2008), they can still happen. Many people are under the impression that infections are the result of contact with a foaming-at-the-mouth wild animal, like a raccoon or bat, but transmission is most often linked to dogs and strays in foreign countries. Also note that it doesn't take a full bite, but rather the virus could be passed from a scratch or even a rabid animal's saliva getting into an open wound.
Once you've been exposed to rabies, symptoms can mimic those of the flu, including headache, fatigue, and generally feeling unwell, and as the virus invades the central nervous system and infects the brain, victims can experience anxiety, confusion, hallucinations, fear of water, insomnia, and can even die.
If bitten by an unfamiliar animal, it's important to remain calm. “It’s not like a poison that would paralyze you instantly within 10 minutes,” Aaron Glatt, MD, chairman of medicine and a hospital epidemiologist at South Nassau Communities Hospital in Oceanside, New York, previously told Health. “You really need to get this addressed, but it is an infection that takes some time to spread in your body.”
Make sure to clean the bite thoroughly with soap and water, and then seek expert assistance. A doctor will administer a first dose of the post-exposure rabies vaccine, which can help prevent the virus from getting into the central nervous system, according to the World Health Organization. You’ll receive three more doses, spaced out over a 14-day period. You may also be treated with human rabies immune globulin, according to Dr. Glatt, which provides antibodies collected from people who have had rabies.
if they vary from the script, they could be liable for any bad outcomes or not have the bill paid for by insurance, which then lands on the patient himself/herself.....
eg....there are certain protocols for certain symptoms...they go by the most reasonable and common explanation for symptoms.....and treat accordingly....
Yes, pretty much experimental treatments is the only hope, and they don’t work either.
Does cooking kill rabies?
JMHO, but there is no intellectual curiosity in medicine anymore. If a woman, especially if you’re a woman, and present with anything from increased heart rate to breathless feeling, it’s likely to be diagnosed as a panic attack.
This woman returned several times to the ER and each time was turned away with the an “easy” diagnosis. I’m not a Dr. but correct me if I’m wrong. If blood tests were run, and rabies is an infection, wouldn’t she have had an elevated white blood count?
Bite him back yes.
I was bitten by a bat and had to get the rabies shot regime. The shots are not that bad but it ain’t fun. Also the heath dept calls you all the time to see if you made your infusion appointment. If you miss they send the cops.
The ER experience in the US is pretty bad... I got 3 different and conflicting instructions on a recent ER visit, the Attending, the intern/resident (not sure which one he was) and the nurse, all gave me slightly different information and at times contradictory info.
Not so much on the actual diagnosis, but for the follow up stuff I would need to be doing....
I know why this happens, the general instructions were similar, but the details were different.
I really do feel for the elderly or those who are for other reason incapable of advocating for themselves, because if you are a passive patient, this is the kind of stuff that will happen.
Of course, My bet is she never told anyone that she got bit.. and none of the doctors/staff asked her if she had been.
So they diagnosed on symptoms rather than on doing a full patient background which would have almost instantly made think of possible infections... etc
That and the Urgent Care she visited, almost certainly didn’t even see a doctor, most likely was a PA if she lived in a state that allows them.
Yes. If someone comes in with fatigue and soreness, you don’t order three different tests that add up to $10K.
You do a physical examination to find a cause, and if you don’t, you order a few tests and monitor. If the symptoms get worse, you do more expensive tests.
People complain about the high cost of medicine, but that makes no difference to many of them when they have an irrational axe to grind.
Symptoms for rabies are notoriously vague and non-specific. And even when you begin to display the most banal and minor of them, it is too late.
If she had been correctly diagnosed with rabies, she would be just as dead.
Rabies is viral. It doesn’t show in blood tests. You have to order specialized tests that aren’t carried out often, and have to be sent to special labs, not the usual ones.
Elevated white blood cells can be a huge number of things.
But they make our meds!......................
Yeah, one gal told me she was calling an ambulance before I dropped dead in her office. She was serious I wasn’t going to last the day. I’d only gone to see her for a torn meniscus. Soon to be 10 years and they still won’t fix it. Oh, and I’m still alive.
On the opposite end, one moron stood in hallway outside the exam room and determined he didn’t need to stitch my bleeding head up after I’d fallen off a ladder. Of course, he charged me for the hallway consult.
“Sometimes we forget that our patients travel to places where there are a lot of zebras.”
So true. When I practiced in Alaska rabies was always in the back of my mind due to the high percentage of wild and domestic canids that were infected. When I lived in SE Idaho I had a patient who may/may not have been scratched on her scalp by a bat. Fortunately she had the bat and it tested negative but not before treatment had been started.
I once encountered a patient in Alaska with flu-like symptoms in May. When I entered the room his neck was swollen up so much it was wider than his head. That was weird. One of his white blood cell counts was extremely elevated. I researched this in a pathology book (which is a clue to how long ago this happened!). I suspected trichinosis. I asked him if he had eaten any undercooked pork or bear meat recently. Yep, he had eaten some undercooked grizzly bear steaks from last Fall while he and his buddy were out Spring bear hunting. You know - eat bear, hunt bear! He damn-near died and had life changing disabilities after he recovered.
So yeah, its often horses but sometimes there are zebras around. Its vital to understand not only the environment where you practice but what kinds of other environments your patients might visit. Like the Eskimo family who developed trichinosis from eating fermented walrus flipper...
People don’t get this. Even if she had gone to the ED with even the mildest of symptoms such as anxiety or a headache, they are already going to die.
I knew a guy who took a bite out of a fish head from a chum barrel on a fishing boat just to get the hung over guys to lose it.
I don't think he would have chewed on that flipper...
nor did she ever receive a rabies vaccination in her lifetime.
You ever hear of that Alaska native delicacy “stink head”?
I don't know how. Every time I see a medico, any medico, I'm asked if I've been out of the country lately.
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