My dog bit me -- ER or no?

July 4, 2017 7:37 PM

I'd like to avoid an ER bill but I'd also like to not get infected.

This afternoon my dogs got into a bad fight with each other. I got in the middle and tried to break it up, and I got bitten for my efforts: http://imgur.com/a/G4NUK.

I'm not here to discuss the dogs, just the bite.

I immediately doused it in hydrogen peroxide and squeezed the blood out of it. It hurt like hell but didn't seem ER serious to me. The one on the left is about 3-4 mm deep, and the one on the right is mostly surface, maybe 2 mm. Still, I called around to find an urgent care that was open and went in immediately. This was about 6 hours ago now.

Preface with: I'm a critical care nurse. I don't have a ton of experience with dog bites in the ER setting but I have enough to know what they'll do if I go to the ER and that it'll cost thousands. I'll get lidocaine to the arm, a tetanus booster, a good cleaning, a prescription for antibiotics, and they will tell me it's mandatory to start rabies shots. They'll do a mandatory report on my dog.

I don't feel like any of that is necessary. Not the bill, not the rabies shots, maybe the clean out. Definitely not stitches. So I went to the only urgent care open this afternoon when it happened and they refused to treat, saying they don't do dog bites and I have to go to the ER. I told them straight up I was not going to go to the ER and their secretary said I had to, and that every other doctor in the area was going to tell me the same thing. Instead I went to walmart.

I got rubbing alcohol (I know it can damage healthy tissues in a wound but I'm not worried about my ability to grow new tissue; I was worried about cleanliness) and a bunch of other supplies. I knew I'd done everything right to start with, cleaning it out immediately and letting it bleed freely for a few minutes to get any junk out, but I wanted to be sure. My sister is also a nurse. I called her to come over and we cleaned it out GOOD. Spread the edges, pushed aside the old tissue, and got all up in it. Rubbing alcohol, sterile wound wash, hibiclens, the whole 9 yards. It's currently got neosporin on it and I'm keeping it clean and covered. The puncture is still oozing a little blood but not much. I have no nerve/tendon/muscle damage that I can tell. It wasn't a ripping wound, just an in-and-out bite. I also had a round of Penicillin VK 500mg sitting around from a prior dental foray, and I've begun taking those. They're a bit wimpy for antibiotics, but if a doctor won't do a simple clean and antibiotics prescription, they're what I'm stuck with. I'm 100% sure that the dogs both are up to date on their vaccines, and I just had a TDAP shot 4 years ago.

I think it's ridiculous that I can't get a doctor to treat this, but I don't want to be the stubborn healthcare worker who won't get their own illness treated and get infected. Though of course, I would know if it was getting infected. The ER doesn't exactly close. I can always go if it's getting bad. I don't think it will. What do you all think?

(And the mandated report for the dog isn't why I'm avoiding treatment either. She'll be on a list but they wouldn't require her to be put down unless this happened several times or was egregiously unprovoked. It wasn't unprovoked, and it's not going to happen again.)

posted by Sherbil to Pets & Animals (23 answers total)

Do you have evidence that your dog was vaccinated for rabies? I got badly bitten by someone's cat once and went to the ER (I also tried an urgent care and was sent to the ER - this was because of possibly needing a rabies shot), and once the owners produced a certificate for the cat's rabies shot, they were willing to sign off on not giving me rabies shots. It also helped that it was a house cat. (In your case it helps that you're the owner of the dog.) They also let me hang out in the ER until the certificate came in; they didn't want me to get a shot immediately. Apparently there's actually a window of a couple weeks to start rabies shots. This may vary by state and animal, but that was my experience.
posted by unannihilated at 7:50 PM on July 4, 2017 [1 favorite]

Response by poster: Yes. We have papers for both of the dogs involved, and the one who bit me I just got in February of this year and had vaccinated for rabies and everything else when I got her. I believe the shelter she came from had already had her rabies vaccinated when they microchipped her, but my vet wanted to redo it just to be sure, and now I'm *really* glad they did because it means I can be 100% sure.

Despite this, they are still very pushy about the rabies shots. If I go, I'll outright refuse that part as well as the tetanus booster. As long as it's within the last 5 years, it's supposed to be good; mine was 4 years ago.
posted by Sherbil at 7:58 PM on July 4, 2017

I saw my primary after a dog bite and she gave me antibiotics with no drama. Maybe call your primary to see if they're willing to see you?

I personally wouldn't go to the ER in your situation because I hate dealing with the ER unless I'm on the urge of death. It would be smart for you to get appropriate antibiotics as a precaution, but if the ER is the only way that's possible, you're otherwise healthy, and you're able to keep an eye out for any sign of infection, I understand your decision.
posted by metasarah at 8:00 PM on July 4, 2017 [2 favorites]

Best answer: Eh, you're a nurse, you did proper care, and you explained the potential downsides well. I looked and the pics and they look clean, although maybe a bit deep.

If it were me, I'd wait. If you think it's infected tomorrow or the next day you can seek care then, possibly from a primary care physician or other non-ER place. This most likely cannot hurt you badly in the next day or so, the dogs have rabies shots and you are current on tetanus.

Ps sorry about this -it is hard and stressful to break up a dog fight- maybe keep a few brooms in easy reach if it might happen again.
posted by SaltySalticid at 8:03 PM on July 4, 2017 [9 favorites]

Response by poster: It was partially my fault it happened :(. The dogs are known to have issues with each other in stressful situations and are under close supervision. They were on edge from 4th of July fireworks blasted off by unwitting neighbors and I didn't realize it until one of them decided it was fight time. Luckily they didn't do too much damage to each other (though I'm getting both of them on antibiotics immediately when the vet opens tomorrow morning). We'll definitely have stricter precautions now. They're both rescues.

I don't have much established rapport with a primary doc. I don't have much in the way of health issues yet (still young). But I do have someone I can schedule a visit with and see what they say. I'll try that tomorrow.
posted by Sherbil at 8:22 PM on July 4, 2017

Best answer: I've done this often with animal related injuries (farm) and did not die or get an infection. I think if it was a deep cut I'd feel differently but that's barely through the skin and you're a nurse so you already know how to clean it out better than most people. Your primary care doc will likely give you antibiotics as noted above, without the rabies shots.

Also I doubt the urgent care people are correct about the rabies, I know many people who've been bitten and not had rabies shots. Even a friend who was bitten by a stray while riding her bike didn't get rabies shots. It's vanishingly unlikely that a pet animal has rabies these days in the US.
posted by fshgrl at 8:35 PM on July 4, 2017 [4 favorites]

Best answer: I'm so sorry this happened! If it was a cat bite, I'd say don't hesitate to go to the ER, because those turn bad fast. But for a quick dog bite puncture wound, it sounds like you did proper wound care.

If it shows any signs of infection/worsening, go to the ER and take the dog's rabies certificate/proof of vaccination with you. Tell the truth: you intervened in a fight between dogs. The dog didn't target you, you accidentally got in the fray. Emphasize your own role. I don't say that to place blame--this situation sucks all around, and isn't your fault--but it may help to make very clear that this is not a dangerous dog. It's not a case of dog on human aggression; it was a dog fight (those happen) with an unfortunate human error (those happen a lot).

It helps that it's your dog. Bite report regulations vary geographically, and there's a chance you wouldn't even have to report your dog (where I am, in Oregon, a bite report is only mandatory if it came from a presumed "dangerous dog." In your situation, you could probably convey the situation and make clear that the dog is not dangerous).

(I know this question is not about the dogs, but because they've come up in a couple responses: t I hope you'll ask another question if you have ongoing concerns about their dynamic. Bites happen, but if the dogs' fights are escalating frequently and everyone in the household is stressed out, it may be time to seek additional help/options.)
posted by adastra at 8:53 PM on July 4, 2017 [1 favorite]

I have gotten similar puncture-wound dog bites breaking up fights before. I never went to the ER for those or took antibiotics, just cleaned them well and kept them clean with rubbing alcohol and Neosporin until they healed. I'm fine.

I don't know where you're located, but it seems extremely unlikely that you would have to take rabies shots if it's your dog and you have proof that your dog was vaccinated. I've honestly never heard of anything like that.

And be kind to yourself. You are doing a good thing by taking care of rescue pups and 4th of July is the worst day for dogs. Shit happens.
posted by the turtle's teeth at 9:05 PM on July 4, 2017 [4 favorites]

Add me to the anecdotal chorus of people with successful self-care outcomes from worse dog bites than that one.
posted by flabdablet at 11:15 PM on July 4, 2017 [1 favorite]

Thirding (fourthing?) that the ER is unlikely to have you start a rabies vaccination schedule if you can produce proof that the dog(s) involved are up to date on their vaccinations. Experience level: Trip to the ER for dog bites much worse than yours from a neighbor's dog with up-to-date paperwork.
posted by asphericalcow at 11:36 PM on July 4, 2017

Response by poster: I live in a red state so what my senators want in terms of healthcare is for me to die if I can't afford a ridiculous $3k+ ER bill for a simple dog bite cleaning + antibiotic prescription and they don't give a crap as long as they get more money. Trust me, being a healthcare worker has made me acutely aware of how awful all of this is. I already called my reps when a close friend of mine ended up with CML (a chronic leukemia with lifelong prescriptive needs to the tune of at least $500/mo., and was much higher before the drug came off patent to go generic). He's also screwed in the future if the pre-existing conditions clause gets scrapped. They don't care.

The one thing I can say is that being in healthcare has saved me a fortune. When I need medical care, I know the cheapest avenue that's still reliable. Like with this: Got supplies to clean well, spent ~$35, but didn't pay $150 at urgent care and didn't pay $3k to the ER. Big savings. My husband is in school and I'm helping my friend with CML while he's unable to work due to them tweaking his meds. The dogs are also costly. I don't have money to toss at stupid healthcare costs.


RE: The dogs, they've fought before just like this. The difference is my husband is usually home to pull them apart and he wasn't this time. I couldn't. It happened because our bigger dog was on the wrong side of our baby gate, where he could lunge and push it out instead of lunging and the sides of the door holding it from being pushed in. I didn't realize until it was too late. It won't be happening again. Husband and I have already sat down and tightened up our rules. These dogs actually get along incredibly well as long as the situation is not tense and there is no food involved. I would consider rehoming them if I thought anybody would care for them as attentively as we do, but I really don't. Bulldog breeds with behavioral issues don't have a good time with adoption :(. If my female dog had bitten anyone else they'd probably be scared of her and have her put down. I don't begrudge dogs their natures, but biting can't happen again. We've taken steps to ensure it won't. I'm also going to see if I can find a behavioral specialist out of town to consult. The one in town hasn't helped.

_____________

Update on the wound: It still hurts, still trickling just the tiniest bit of blood (I think when I rotate my arm, it shifts the internal part of the wound and it trickles a drop of blood), but is still clean and I'm changing the dressing every six hours. I'm heartened at these reports of so many having bites that were fine. And if my cats had bitten me, I absolutely would've gone to the ER. I've seen people laid low from infection due to routine cat bites in my ICU. They are much dirtier.

I'm going to go into my doctor's office tomorrow and see about some Augmentin. Seems to be the antibiotic of choice for a dog bite.
posted by Sherbil at 2:27 AM on July 5, 2017 [1 favorite]

I've been prescribed Augmentin and Keflex for deep dog bites and had good results with both.
posted by flabdablet at 3:14 AM on July 5, 2017

I'm also an RN and have gotten in the middle of dog fights (I have Frenchies). Keep the puncture wounds clean with saline flushes using regular contact lens saline solution (although you can buy boxes of 10cc saline flushes on Amazon!), see if you can get an Rx for Bactroban - it's excellent for dog bits and generally good to have in the house and get the script for the Augmentin. Other than that, you know what the s/s of an infection are. Just keep an eye on it.

Future reference; I found an excellent way to break up fights is to throw a blanket over both dogs. It stops fights pretty quickly. So does throwing a glass of water on them. ;) Feel better!
posted by dancinglamb at 4:19 AM on July 5, 2017 [1 favorite]

Response by poster: My dogs are both bulldogs, one an American bulldog and the other a Staffordshire terrier. Brooms and blankets don't do crap to break them up (tried both today). I'm going to need to get a good strong thick stick to slip in their mouths to break them up in the future. I don't have the strength to throw myself into their fray and not get hurt like my husband can, but being a nurse you learn to get good with procedural methods, and I know I can get a stick in their jaws and break them up that way. We're putting new plans in place now.
posted by Sherbil at 4:57 AM on July 5, 2017 [1 favorite]

It's not an emergency anymore. If you decide in favor of treatment, opt for a non-ER provider.
posted by SemiSalt at 5:15 AM on July 5, 2017 [1 favorite]

Response by poster: I already set up for an appointment with my doctor this morning, and the secretary didn't say anything when I told her it was for a dog bite, so I think I'm in the green. Thanks you all :). I appreciate the peace of mind in a hectic moment.
posted by Sherbil at 5:46 AM on July 5, 2017 [2 favorites]

We used to have two dogs with similar issues, and I've been to the ER a couple times for bites from breaking up a fight. In my experience, they flush the wound with saline solution and give you some antibiotics, plus an updated tetanus shot if you need it. I've had success with saline flushes on the wounds on the dogs too, so I recommend continuing to flush with saline and getting some antibiotics just in case.

Obviously regulations are different everywhere, but where I am the ER staff just asked multiple times what happened. I was insistent that they dogs were fighting, not attacking me or my husband, and that we just got in the way, and that this wasn't some sort of unusual (rabid) behavior. In which case they didn't even mention rabies shots and didn't report the dogs.
posted by thejanna at 5:53 AM on July 5, 2017

This exact thing happened to me. No one made a report on my dogs or made me get rabies shots (because I knew my dogs had their shots). I did go the ER (sent there by my GP) because I'm not a nurse and couldn't DIY my own wound care. They cleaned it out good (so painful!), gave me a TDAP because I wasn't up to date, some abx and a painkiller.

But again, as soon as I explained they were both my dogs, and I was breaking up a normal dog fight and the bite was an accident, and both dogs were UTD on vaccinations, no one said anything about reporting.
posted by soren_lorensen at 5:54 AM on July 5, 2017

I wanted to add another "Red State" data point. The one and only time I did go to the ER for a dog bite, it was a younger dog with sharp puppy teeth, one of which grazed alongside the outside of my finger and left a long, shallow cut. (Very different than the puncture wounds I've gotten other times, and which you showed in your pic above.) This was also sustained breaking up a fight between one of my dogs and a new rescue, both of whom were 100 percent up to date on shots.

At the ER I got stitches, a tetanus shot and antibiotics. No talk at all of rabies shots. They did however make a report to the sheriff, and an officer came to my ER cubicle to interrogate me about what happened, which was stressful and scary in my hyper-adrenaline woozy-from-pain state. Even though we explained that the dog had shots and we could produce vet records, the sheriff said they would have to come by at a later date to make sure the dog wasn't rabid. This stressed me out a lot (fear of cops) but we never heard from them again.

But I know a woman in a town two hours away who got pretty severely mauled breaking up a dog fight and she explained at the ER that they were her dogs and she got in the fray and it was an accident, and apparently they have no legal duty to report there, and didn't. All this stuff really varies not just by state, but by county and town. So it's really tough to generalize.
posted by the turtle's teeth at 6:51 AM on July 5, 2017

ER? As a nurse? If you have no special condition that would suggest taking a preventive antibiotic, I would not care about it. This is not a dog "bite". This is just a dog "snap".

Wash. Wash with Alcohol. Put triple antibiotic cream on it. Small patch. Done.
posted by yoyo_nyc at 8:56 AM on July 5, 2017 [1 favorite]

Also keep in mind for the future that an injury like this may be covered by your homeowner's insurance.
posted by eas98 at 9:08 AM on July 5, 2017

(Oh my goodness, do not involve your homeowners insurance co with anything to do with a dog bite unless you absolutely have to. You'd be practically giving them an excuse to drop you.)
posted by Sweetie Darling at 9:15 AM on July 5, 2017 [6 favorites]

As someone who suffered multiple dog bites on my arms and legs a few years back I'd say there's no reason to go as long as you follow proper wound care. All they did at the ER was lavage the wounds and bandage them. They were too ragged to stitch and were just left to heal on their own.
posted by runcibleshaw at 10:14 AM on July 5, 2017