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Way OT - bat bite

I gather the injection series is uncomfortable, but it beats the alternative.
No, it is important to know that the normal post-exposure injection series is no worse than a flu shot series. Challenger got an unusual approach (full court press) as his post-exposure treatment was delayed (not his fault) by more than a week. So, he had infiltration of the wound with presumably immune globulin --- the three shots in the thumb---ouch! In addition he may have been given big doses of immune globulin in the shoulders and thighs. I am guessing about the identity of those shots. But with the delay the virus got a running start potentially. So, much more intense measures than usual were needed. I'll bet there were a few phone calls to experts and hallway discussions to figure out the correct regime in this unusual case.

Challenger, What is the plan going forward? I am sure you have not seen the last of the pointy end of a needle. ;-)

Denis
 
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No, it is important to know that the normal post-exposure injection series is no worse than a flu shot series. Challenger got an unusual approach (full court press) as his post-exposure treatment was delayed (not his fault) by more than a week. So, he had infiltration of the wound with presumably immune globulin --- the three shots in the thumb---ouch! In addition he may have been given big doses of immune globulin in the shoulders and thighs. I am guessing about the identity of those shots. But with the delay the virus got a running start potentially. So, much more intense measures than usual were needed. I'll bet there were a few phone calls to experts and hallway discussions to figure out the correct regime in this unusual case.

Challenger, What is the plan going forward? I am sure you have not seen the last of the pointy end of a needle. ;-)

Denis
In giving more thought I think you hit the nail on the head. The PA told me that I'd be getting shots in the thumb, immunoglobulan, a tetanus in the shoulder plus another rabies shot in the thigh. When the nurses came to give me the shots they didn't mention any thumb (site of the bite) shots so I told them the PA said the thumb should get poked too. She left to ask about this and came back saying they will be giving me thumb shots PLUS an additional two shots of the rabies stuff. The second nurse was being trained, of course 😬, and I think this is why they double teamed me breaking the doses up into 4 shots (3
1.763 oz total based on my slim 210lb "father figure" body weight. That's a fair amount of liquid IMO so perhaps this, and the fact it provided training for the newb, is why they broke it up into 3 syringes?? So I ended up getting 1.763 oz of HRIG in the quads and shoulders not including the thumb jabs. As mentiined, I'll be following up with 3 more HRIG shots which will be simple walk in jabs.
The thumb shots hurt but the needle was really small. The other 4 were long, big gauge needles. They administered them simultaneously (2 thigh + two shoulder) using the good old count down technique. They all had a lot of volume and the pressure from all that liquid was no party but I've certainly experienced MUCH worse pain.
I pride myself in being a good patient although the thumb shots caused me to sweat and wince. The nurse asked if I was OK and I told her she can't hurt me. Don't EVER tell a nurse that he, or she (preferably 😁) can't hurt you.
Like I tell everyone I meet, "don't do what I do".
Thanks to all here for the great advice.
Side note:
When I told the friend, who originally was freaked out about the bite, that I posted on "a machinist forum" to get advice he laughed. He said why TF would I ask on a machinist forum. I told him that this forum has the absolute smartest MFers PERIOD and this, IMO, is the gospel truth. The folks here know errytang!
God bless you all and God bless America bats or no bats.
 
Well if it makes you feel any better there was a girl not far from me in Fond Du Lac WI that was successfully treated for rabies from a bat bite. The first one ever using some new method. If you squeezed it and it did not bleed, I would not sweat it.
The girl you're talking about is Jeanna Giese, and the treatment became know as the Milwaukee Protocol. It's been a while since I did much reading on rabies but last I knew Jeanna Giese is still the only confirmed rabies survivor. All other patients that received the milwaukee protocol eventually died and it's not know why or how Jeanna survived. The milwaukee protocol is considered ineffective now and not recomended. The only real post onset treatment is palative care to make you less miserable. Death takes about a week and seems like one of the more unpleasant ways to go. Thankfully rabies is unique in that while it's (effectively) 100% fatal, it's also 100% preventable. Challenger's friend was right to take it serious, his doctor on the other hand was grossly negligent.

Also important is that rabies enters through the peripheral nervous system, not the blood steam. Not bleeding means absolutely nothing. From the peripheral, it travels to the central and eventually the brain, which is why incubation is so long and depends on where on the body the exposure was.
 
I bet that Chinese locomotive shop in a cave has lots of bats hanging out in the shop. I have no idea if China has rabies or not.
I bet the student nurse was thrilled to do a rabies shot. Now she can brag for her entire career that she gave some dude a rabies shot.
The fact you got the shot is probably not something to impress potential girlfriends. Little boys who like batman will be your friends now.
Bill D
 
@challenger
If you're Doc says you're good, you're good.
It didn't break the skin so zero chance of rabies infection, if the thing even had it to begin with.
Now, off to the bat lathe!
C'mon, we're machinists here, how many times have you had a metal chip stuck in you hand and couldn't even feel it. The girl from the Minnesota Protocol didn't even know she had been bitten

Bat behaving oddly out in the daytime.
Odds it is rabid?
Pretty frekin high
You come in contact with a rabid animal, you get the shots
 
C'mon, we're machinists here, how many times have you had a metal chip stuck in you hand and couldn't even feel it. The girl from the Minnesota Protocol didn't even know she had been bitten

Bat behaving oddly out in the daytime.
Odds it is rabid?
Pretty frekin high
You come in contact with a rabid animal, you get the shots
A broken wing can trigger that behavior too.
 
C'mon, we're machinists here, how many times have you had a metal chip stuck in you hand and couldn't even feel it. The girl from the Minnesota Protocol didn't even know she had been bitten

Bat behaving oddly out in the daytime.
Odds it is rabid?
Pretty frekin high
You come in contact with a rabid animal, you get the shots

Here is a photo frame from the video I took. It definitely had a broken left batwing. This is more visible in other frames of the video but I don't have the patient to get a better frame. Too bad I can't upload the video.
 

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Here is a photo frame from the video I took. It definitely had a broken left batwing. This is more visible in other frames of the video but I don't have the patient to get a better frame. Too bad I can't upload the video.
Do rabid bats become clumsy fliers??? I would think that is possible/likely as rabies is basically a neurological disease. Broken wing as a consequence? I doubt anyone has done a study on the incidence of bats with broken wings having rabies. But, certainly, a broken wing does not in any way rule out rabies. In fact, it might just be the opposite making rabies likely or maybe even highly probable.

Denis
 
No. I picked it up and it bit me.
Seems like EVERYONE that encounters a bat is supposed to be jabbed. If you find a bat in your house your supposed to be jabbed.
I don't think it's quite that bad. Around here the DNR is encouraging people to build bat houses as a "green" way to keep down mosquitos and other insects. Almost all the state parks have one. Here's an article by the DNR about bats. The last question in the article encourages people to build bat houses so they take up residence


When we were kids, we used to have bats in the barn next door. From time to time, they shelter in one of the louvered vents in or garage. They never bother anyone, and we don't bother them.
 
No. I picked it up and it bit me.
Seems like EVERYONE that encounters a bat is supposed to be jabbed. If you find a bat in your house your supposed to be jabbed.

Uh oh. I had a bat in the attic several years ago. I spotted it because of the damn droppings. Found it with the thermal camera. Figured out where it was getting in and repaired the hole while it was out. Still breathing, thankfully.

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I'm not reading this whole thread. Simply put, according to the algorithm put forth by the health department, the bat should be tested for rabies. If the bat is unable to be tested for rabies, you should be treated with post exposure prophylaxis (PEP). It's no laughing matter. Rabies is fatal 100% of the time if you become symptomatic.

Even if only 1% of bats carry rabies, would you play russian roulette with a 1% chance of death when you can just as easily say, "nah, I'll take my medicine instead".

Rabies kills 59,000 people per year. It's only in the civilized world that we are so lucky to have such low exposure rates, and it's almost entirely because we have great public health (ie, vet med) in comparison.

If you have the bat, you take it to the county health department. They send it off for testing. If it comes back positive, you get PEP, if negative you do nothing.

It's really damn simple if you don't have the bat. You go to your big hospital ER. You explain that you are sorry because you don't have an emergency, but you need access to their pharmacy. It has to be a university hospital or similar size or they won't have the PEP. You tell them you were bit by a bat on the thumb. You tell them that according to the post expsoure treatment algorithm you need post exposure prophylaxis. They then give you the shots in the arm. You return at the recommended intervals for further vacccination. I've done it.

Qualifications to make this thread - Formally educated as veterinary technician. Cut off hundreds of heads of pets exhibiting symptoms for testing purposes. Been exposed to rabies in a dog as well as a cat. Had PEP as well as boostered rabies vaccines. I can unequivically say that I am more qualified in this matter than your human doctor who gave you bad advice, and the first thing I was told when I started my career (by the doc from the health department) is that when it comes to zoonotic diseases, you will be the expert and advocate for yourself, because the human clinicians don't have a clue.
 
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I can unequivically say that I am more qualified in this matter than your human doctor who gave you bad advice, and the first thid above exceptng I was told when I started my career (by the doc from the health department) is that when it comes to zoonotic diseases, you will be the expert and advocate for yourself, because the human clinicians don't have a clue.
I agree with almost everything you said except for the very last statement. I would modify it focusing on the rabies question by saying that as a certified family practice physician I know from 40 years of practice experience that 99% of primary care physicians would have advised PEP to the OP given his story. During my career I certainly had many opportunities to deal with bat exposures in my patients AND to discuss with peers cases we had encountered. I can also say that the importance of rabies prophylaxis and the dire consequences was drilled into our heads as medical students and residents and we were required to watch training films (no videos in those days) of people ill and universally dying of rabies. Like any profession (I am sure veterinarians and vet techs as well) there are a few who somehow miss the message. Based on what we know of this case, the advice given was definitely an outlier. Hopefully the OP will so advise his doctor. Period.

At the risk of over-complicating the issue, the WHO categorizes exposure as follows:

WHO PEP Rabies Recommendations

WHO recommends PEP for category II and III exposures (see Table 1).The WHO rabies exposure categories are:
Category I touching or feeding animals, animal licks on intact skin (no exposure);
Category II nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure);
Category III single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks, exposures due to direct contact with bats (severe exposure).
ID PEP schedules are cost- and dose-sparing and cost-effectiveness increases with numbers of patients seen in clinics. If a repeat exposure occurs within 3 months of completion of PEP, only wound treatment is required, neither vaccine nor RIG are needed.

All of this information provided in post 98 has been included, in some cases multiple times, in this thread except about all other professionals, except those in the veterinary field, being categorically clueless about zoonotic illness. As I recall, we were advised to seek counsel of other professionals and to respect their knowledge and integrity and to seek advice of experts in any field in question if we ever felt unsure of our knowledge base in the subject.

Finally, if there are only one or two cases, (should be zero) in the US per year of rabies compared to the approximately 60,000 cases worldwide, knowledge of rabies risk in bat exposure is pretty good in not just professionals but the population at large.

Denis
 








 
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