Rabies Is Out There - Even Vets Forget It
How many rabies vaccines does your average, well cared for pet get? About one a year in most parts of the US. How many rabies vaccines have I received in the past fifteen years? A series of three vaccines back in 1991. I haven’t needed one since — my antibody titers are sky high.
No wonder vets are widely criticized as vaccine-pushers. We’re addicted to vaccines despite the science that now continually contradicts this income-generating habit. And the worst part? Animals still get rabies. And guess what? We still manage to miss this diagnosis. Here’s a story that illustrates the occasional depths of our clinical dysfunctionality:
About a year ago one of those vet-shopping clients came upon our hospital. He had already been to two different hospitals for an opinion on his son’s new kitten. Both hospitals had suggested the kitten looked too ill to survive and offered to euthanize her. He was still not convinced she couldn’t be saved. With a tearful ten-year-old boy by his side, it seemed impossible not to try. So I carefully examined the scrawny, eight-week-old kitty.
The kitten had been born to a backyard-marauding feral cat who had unceremoniously abandoned her offspring on their front lawn. The kitten had thrived for several days in this family’s care but soon began to display bizarre behaviors. When I saw her she was trembling and unstable on her feet. She could not walk in a straight line. Her eyes were dancing back and forth and — as a final demonstration of her illness, she lunged at me as if to bite. (Interesting…)
The father quickly tried to assuage my alarm over the near-miss: She’s been doing that for two days but her teeth are only big enough to leave scratch marks. "Are they deep scratches?" I queried gently. The boy cautiously offered to show me his hands: Not too deep — I think. (Right…)
It was at this point that I asked the technician to watch over the boy and kitten, whispering, "rabies suspect!" in her ear on my way out the door with the father. I drew him aside and explained the possibilities. While a case of rabies had not been confirmed in our county in over thirty years, the neighboring county had seen plenty. I explained that while I felt 90 percent sure this was not a rabies case, just a neurological manifestation of some other viral or bacterial disease (Feline leukemia, feline AIDS, toxoplasmosis, etc.), the teeth marks on his son’s hands had changed everything. The Health Department would have to be called. The kitten would have to be euthanized. It was out of his hands.
If I had expected any opposition to my recommendation, the mention of the word rabies defused that bomb immediately. This father had spent all morning trying to find a vet willing to actively take on the kitten’s case for his son’s sake. Suddenly he couldn’t agree to euthanasia quickly enough — for his son’s sake.
Then it was my turn to explain things to the tearful ten-year-old since Dad was slightly useless in this capacity (he tried but it really wasn’t working out well). I explained that sometimes kittens are so sick that they can make us as sick as they are. And he was such a healthy boy that we couldn’t risk his health for a kitten that was no longer enjoying her time on Earth. After telling him to be brave and say good-bye, I offered to have him come back tomorrow to pick out a healthy kitten from our hospital (we had plenty).
Tears all around (the tech was sobbing), we finally took the kitten away to euthanize her. Next up: the Health Department. They couldn’t send a courier for six hours. But they wanted the kitten now(!) and they wanted the child to go to the hospital immediately(!).
I had never had direct dealings with the Health Department, and despite their transportation problem, they were extremely helpful and appropriately concerned. I was pleasantly surprised. But guess what? I was the one who had to cut off the kitten’s head and drive for over an hour in heavy traffic to get the dead kitten tested for rabies.
This is one of those times when you just don’t get paid enough for your work. My other clients had to be cancelled. My hospitalized cases had to wait. My surgeries had to be rescheduled. Everything else, along with the kitten’s head, had to be put on ice for this little boy. And it was worth it.
In less than ten hours (they worked until midnight) they had an answer: inconclusive. Virus in the brain, for sure. Consistent with rabies? Yes, but only with very early infection, while the kitten’s symptoms suggested a more advanced stage of the disease. Too close to call.
A post-exposure rabies vaccine had already been administered to the boy. He was scheduled for at least two more. But don’t fret unnecessarily on his behalf. Gone are the traumatic intraperitoneal vaccinations of years past (remember the thirteen shots in the belly-button story your mom told you?). Now the vaccines are administered intramuscularly. And, while still not quite pleasant, they don’t provide that disturbing, horror-movie vision anymore.
So now comes the inevitable question: How did two other hospitals miss this seemingly obvious, potentially deadly diagnosis? Simple. The same way I almost missed it. Had the kitten not acted with hostility I might never have made the connection. Ironically, though aggressive behavior is the pop-culture hallmark of rabies infection, most rabies-infected animals are simply depressed, disoriented and neurologically not quite right. So many of my cases could fall into this category and I (almost) never think: Rabies!
How is it that a disease as deadly as rabies can slip through our consciousness so effectively? Perhaps it’s because we live in Miami where rabies is a thirty-year event. But that’s still no excuse. Each and every day we work we vets are in a position to see things outside the realm of the normal abnormals. It behooves us to stretch our minds beyond their expected limits, especially when to do so might save a child’s life.
Vets say the word rabies several times a day. We provide vaccines with deadening regularity. We go to conferences where we argue for hours on the merits of vaccination or attempt to disprove these. The term is in every glossy magazine we read. But all of that seems only to have desensitized us to the reality of the disease.
Rabies happens. Neither our high-minded discourse nor our very best prevention techniques count for very much if we simply forget it.
Dr. Patty Khuly
Image: Genevieve Dietrich / Shutterstock