Tuesday, March 29, 2016


cross posted from my usual blog.

Rabies is around in the Philippines, so anyone bitten by a strange dog gets a series of shots.

Our dogs get their rabies shots, so usually we just reassured those bitten by George, the Killer Lab, but once tiny PuffPuff bit the massage therapist treating Joy, and his shots were out of date, so we had to pay for treatment.

No, I never saw a case in Africa: The protocol there was to go to an area, give all the dogs their rabies shots and paint their rumps, and then put out fresh meat and have a sniper shoot any dog without a paint jobs. After independence, alas, when bullets and snipers got expensive, some countries ended up with epidemics.

Here in the Philippines, the vets go to rural area to give the dogs the shots, and locals kill stray dogs. The local clinic will arrange for you to get the shots at a minimum cost, or you can pay 20 dollars  to buy the vaccine at the pharmacy and give the shots yourself.

In the USA, however, bat bites are a major cause of rabies. I once blew the budget of a small local township where I worked after a young girl got bitten by a bat when she opened a pantry door. Since bats don't usually attack, we had to assume it was rabid.

Nowadays, the regimine is anti globulin and three shots of the vaccine. Back then, it was 24 shots of the vaccine....by shot 12 she was getting local reactions and we started running out of places to give the shots. Ouch.

Cats also can carry rabies, as can racoons.
I remember when we had an outbreak and had to get the cats rabies shots: we took three cats in our cat carrier, and they got lose. Catfight!

Rabies is fatal. Usually you keep them comfortable with deep sedation until they die. So if you are traveling to a high risk area, or might be in contact with rabid animals, you are advised to get the shot.

But a few cases of people who had never been vaccinated beforehand have lived. LINK LINK

treatment is inducing a coma and using a breathing machine, while giving rabies globulin and anti virals. Even with this very expensive treatment, few live.

SCI AM article describes treatment.

The Milwaukee protocol via Wikipedia

Willoughby's goal was to put Giese into an induced coma to essentially protect her from her brain, with the hope she would survive long enough for her immune system to produce the antibodies to fight off the virus. Giese was given a mixture of ketamine and midazolam to suppress brain activity, and the antiviral drugs ribavirin and amantadine, while waiting for her immune system to produce antibodies to attack the virus.[6] Giese was brought out of the coma after six days, once signs of the immune system's progress became apparent.
After infection[edit]After 31 days in the hospital, Giese was declared virus-free and removed from isolation. The extent of brain damage she had suffered was of initial concern, but while she had suffered some, the disease (and treatment) seemed to have left her cognitive abilities largely intact. She spent several weeks undergoing rehabilitation therapy and was discharged on January 1, 2005.[9] By early 2005, she was able to walk on her own, had returned to school, and started driver's education, indicating a successful recovery.[10]

only 5 patients out of 36 survived using this protocol.

and there is a suggestion that the drug ketamine has anti rabies virus properties.

Ketamine is used to induce anesthesia, and works without depressing respiration or blood pressure. Alas, often adults who got it also got terrible nightmares, so now it is used in the USA only to put one to sleep (e.g. in Caesarian sections, where you dont want a baby half asleep from mom's anesthesia and you can't or don't have time to do a spinal). They also use it for kids for things like minor fracture setting, because unlike adults, kids don't get nightmares.

In Africa, we used it when we couldn't do a spinal anesthesia or local anesthetic block: because we didn't have a trained anesthetist. We put it in an IV, and gave it until the patient stopped moving, then slowed it down to start surgery. When the patient started moving again, we increased the rate a bit. Only one problem: Once we needed something, so the guy watching the drip (who was our floor scrubber) went out to get it, and the patient started hypoventillating and turning blue. No nurse either, so I had to break scrub and stop the drip. Luckily his breathing came right back, so I didn't have to intubate him.

Since it is used for animal anesthesia, some has been diverted to get high as a "club drug".


Headsup AnneAlthouse

No comments:

Post a Comment