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Saturday, January 28, 2012

Cat Scratch and Rabies

There came a point when I thought I would become immune to medical emergencies and that nothing would scare me anymore. But each time my daughter is subjected to one, I'd still be overwhelmed with tension and anxiety.
Hoping this will be the last time this card will ever be updated
Monday was an extra day off for us because of the Chinese New Year celebrations. Tibs and I already had a wonderful plan in mind on how we would be spending that day - Breakfast Al-fresco, Couch Potato Time, Afternoon Gardening + Arts and Crafts with Maia. I'm beginning to think planning is not really something that works for our family because just a minute after we're done with breakfast, I heard Maia wail in pain. I ran to see what's wrong and saw the cat scratches on her right foot. My first thought was, MAN THEY ARE BLEEDING. Then Nov 2010 came flashing back to me. On Nov 2010, Maia was bitten on the hand by a stray little kitty that she picked up and went all giddy with. Kitty was of course not happy with the gesture so she went for Maia's hand. It was just a puncture wound but I was told cat bites are even more dangerous than dog bites.

I panicked and felt almost like a headless chicken. I didn't know what to do. Rabies is such a scary thought normally associated with death. I texted our Pedia and I was told to go to the nearest Animal Bite Center. I had no idea where that was so I went and searched in the internet. We have one at the City hall but since it was a holiday (and already past 6pm) that wasn't a good option. RITM was also just 30 mins away but they too only accept patients during office hours. After about an hour of swimming in worry, I sat down, organized my thoughts and forced myself to calm down. I decided to read/research more on first aid tips for animal bites and wait for the following morning. Although I felt it was something urgent, at that point I also thought there was really nothing else I can do. We have limited resources not having our own car to mobilize us in searching for bite centers.

LIGHT-BULB MOMENT FOR ME: Make a list of emergency numbers - hospitals, clinics, doctors, ANIMAL BITE CENTERS, Police Station, Fire Station. What else am I missing?

My first instinct was to secure the cat so we immediately bought a cage to place the cat in. We wanted to keep it healthy for observation in the next few days. Meanwhile, we tended to the puncture wound. Made sure it was clean. The following day we headed to the municipal bite center over at the Dasma City Hall. When we got there, we were told that Maia's bite was a Cat III. She was to be administered the full course of the post-exposure treatment. If I recall it correctly, the first day (day 0) Maia received 7 shots on the puncture site itself and one anti-tetanus shot on the shoulders. It was really heartbreaking. But it needed to be done. The succeeding visits (day 3, day 7 and day 28) were a lot better. On the last day actually, it seemed like the little girl was already immuned to the needles so there was no need to restrain her. I remember asking the municipal health officer then how long is the effectivity of the vaccine and if my memory serves me right, it was good for 5 years. I felt relieved but thought I really didn't need to know because I will never let that happen again.

Well, I thought wrong again. Last week, I was torn -- do I take blindly the information that I was told or do I bring the little girl back to a bite center. I scoured the web again for something that can help me decide and I chanced upon this very informative write up from WHO. Here's a summary of the recommended treatment and the bite categories:

Table: Recommended post-exposure prophylaxis for rabies infection

Category of exposure to suspect rabid animalPost-exposure measures
Category I – touching or feeding animals, licks on intact skin (i.e. no exposure)None
Category II – nibbling of uncovered skin, minor scratches or abrasions without bleedingImmediate vaccination and local treatment of the wound
Category III – single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, exposures to bats.Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound
After that first brush with animal bite, I immediately made a shortlist of the nearest hospitals that housed bite centers. After reading this, we dressed and brought the little girl to the nearest bite center in St. Dominic Medical Center in Bacoor. When we got there, they examined the wound and confirmed to us that she indeed needs to be administered the booster shots. They were to be administered in Day 0 and Day 3. The nurse commended me for keeping Maia's vaccine records. He said that had I lost it, we would probably have been advised to undergo the entire full course of vaccinations again. I heaved a sigh of relief and whispered a prayer of thanks.

Maia already finished the 2 shots. She tells me each time she was given the vaccine that she's mad at me and at the kitty. But all that was immediately erased by a trip to the nearby McDonald's store for her chicken fix. Yes, she's mababaw like that.

What are the lessons I learned from all this? Well, a lot. I'm glad I've already gotten rid of the guilt but I do wish I have more guts to let go of the cats. We have two kitties who were strays but we've had them for almost 3 years now. How do I get rid of them? I really do not have any idea. If only we have money to give them anti-rabies shots, that would solve my problem but for now we don't, so the only prevention we know is for the little girl to stay away from them. I am darn hoping she has also learned her lesson/s.

I don't wish for anybody to be in this situation but just in case you'd fall in the same situation here's a long list of helpful, informative reads. Please click here. The first aid tips we got from the nurses were:

- make sure the wound is washed and cleaned well. apply disinfectant and dress with a gauge bandage if the wound is big.
- if you can safely keep the animal for observation, please do. 
- go to the nearest bite center as soon as you can. (from Maia's vaccination card: Proper treatment of possible exposure to rabies includes the earliest administration of potent cell culture vaccine and immunoglobulin)

If you live near our area (Molino-Dasmarinas Cavite) and is at a loss on where you can go, here's a list of the bite centers that I know:

Asia Medic Family Hospital and Medical Center
Phone: (046) 416-1110
Old Pala-pala Road, Sampaloc I
Dasmarinas, Cavite 4114

St Dominic Medical Center 
Phone: (046) 417-2525/(046) 417-2539/(046) 417-2520
Aguinaldo Hi-Way, Talaba,
Bacoor, Cavite

City Government of Dasmarinas Animal Bite Center
Phone: (046) 416 0095 loc 194
Dasma City Hall
Dasmarinas City, Cavite 4114

Here's a full list of ANIMAL BITE CENTERS in the Philippines.


Anonymous said...

Hi Faye this blog is very informative, i was bitten by our pet dog a few days ago whilst playing with her and I used the information here to get anti-rabies treatment.
However I would just like to update a few things which might be useful for some unfortunate netizens living in Dasmariñas who are in
the same situation.

Previously Animaly Bite Center was near City Government of Dasmarinas Animal Bite Center

Its now being relocated here (see Health Center link below) around 200 meters from City Hall near Dasca Cable

The place is a bit crowded and looks like a small clinic (at the time of this writing) but they have somewhat accommodating staff.

Instructions they actually have one but wasn't displayed anywhere so I have to ask how process works which is summarized below:

Goto Information Desk
Ask a queue number for animal bite center
Give the number to animal bite center (its the middle room with Animal Bite Center tarpaulin)
Doctor/Nurse will ask about your problem
Doctor/Nurse will administer tetanus skin test if you have any allergies with it
ote -- Not good if you haven't eaten yet coz it might cause a bit of dizziness but varies for each individual according to the nurs
Wait for 30mins or nurse will ask you to come back designated time
Vaccination will be administered for free if you agree for the dog/cat to be impounded
If not then you would have to pay for the vaccines depending on which category they placed you
ote -- I paid 2,010.00 for category 2. Just read Faye's blog as to how they decide which category they'll place yo
Note -- Vaccines can be bought at Diane Pharma 50 meters outside the health center

Additional Information
Don't forget to ask for Animal Bite Card
For those who are working and on genuine Sick Leave ;) you can ask for Medical Certificate

pyxxie0703 said...

Thank you very much for sharing this update. I know a lot of people can benefit from it. :)

Anonymous said...

You've blogged this ages ago and still extremely helpful! Thanks Faye! My daughter got bitten by a stray cat and had 6 injections. Poor thing! But better safe than sorry :) Thanks again!

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