QUESTION

My dog bit my hand. Since I know he’s had his rabies shot, do I still need to see a doctor?

ANSWER

Not only should you see a doctor—you should have gone to the ER! Why? As a general rule, dog bites on the hand need to be attended to medically unless they are very minor and superficial—and seeing just any health-care provider won’t be enough. There’s a tendency to want to minimize a bite, especially when it’s your own dog, explained infectious disease specialist William Schaffner, MD, but that’s a mistake. The reasons: Even when there isn’t a lot of pain, a dog bite can result in serious injury to soft tissues and tendons. It can cause nerve damage as well as infection and leave you with limited motion in your hand if not properly—and quickly—treated, and it doesn’t matter whether it’s your dog, a neighbor’s or a stranger’s. Dog bites are not just puncture injuries but also “crush injuries,” and either way, they can be more serious than they look. The amount of force from a dog’s jaw can be substantial, so a bite can mash tissue well beyond any broken skin. If the dog grabbed you and then moved its head side to side while holding on—an instinctive attack behavior—it can worsen the injury. What about germs? Dogs’ mouths tend to be somewhat cleaner than people’s mouths, but they are still teeming with bacteria. Your dog’s bite is therefore also an injection of bacteria. If those germs are injected deeply enough, they can easily cause not only a local infection but also a dangerous systemic infection. People with weakened immune systems or diabetes are even more susceptible, but no one is immune. Here are the steps that should be taken if your dog bites your hand: Wash your wound with soap and water immediately, wrap it with some gauze or, in a pinch, a clean towel and head to the ER. Why the ER? Your primary care provider and even a typical “urgent care” facility aren’t equipped to handle the protocols for a dog bite. Tip: Don’t go alone—getting bitten by your own dog is a traumatic experience, and you’ll likely be shaken up, so if possible, let someone else drive even if you think you can drive yourself. Don’t waste time rummaging around for your dog’s rabies certificate—if you’re sure that it’s been vaccinated, you don’t need it. At the ER, your care may include X-rays to make sure there are no broken bones, an exam to determine the depth of the injury, cleaning and debriding the wound (removing any damaged tissue to promote healing) and any needed surgery. (If you were bitten on the face, the emergency department can also bring in a plastic surgeon.) The doctor will also make sure that the injury didn’t involve a compartment—the various tendons in the hand that enable the muscles to make your fingers move are separated into compartments. If you get an infection in a compartment, it can injure the corresponding tendon. Since it’s impossible to isolate the type of bacteria that got from your dog’s mouth into the wound, a weeklong course of broad-spectrum antibiotics is the standard treatment. If you don’t remember when you had your last tetanus shot, you’ll likely be given a booster, possibly the Tdap vaccine, which protects against tetanus, diphtheria and pertussis (whopping cough) and is commonly the one used. You may need a follow-up visit with a specialist if you had surgery or rehab after your hand heals. If the emergency department you go to isn’t part of your health-care provider’s electronic network, you’ll likely be told to let your doctor know about the incident and the care you received…and to give his or her office a call if you see signs that your wound is getting worse—swelling, pain, redness (especially if it’s extending beyond the area of the bite), discharge and/or a low-grade fever. Also consider whether you need to call your vet to discuss the situation. Ask yourself if this was a provoked bite—were you playing roughly with your dog, did he get startled or was a stranger involved? In these cases, it was likely an isolated incident. But do be more concerned if your dog became aggressive spontaneously and talk to your vet about steps to take.