I'll keep the list, just in case...

Well, it's been over two weeks since Isadora bit me, and subsequently died. The vet invoked the rabies protocol, as she should have. However, King County did not feel it necessary to test Izzy for rabies, since she was current on her shots, had no signs of rabies, and there was a perfectly plausible explanation for her unexpected death. So we proceeded on the assumption that the risk did not justify the extreme measures, and so far, that operating assumption appears to be borne out.

I'm not showing any sign of rabies, and this far out from the bite, I probably will never do so, but--just in case--I'll won't recycle that list of people to bite quite yet</oldjoke-again>.

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Facultative rabies

(Facultative: capable of adapting to different environmental conditions)

Well, this past week can be taken out back and shot, as far as I'm concerned.

Isadora had been sick with kidney disease and an upper-respiratory infection for a little while, but we thought we had it under control. She was getting fluids intravenously, and we had a plan for when she resumed eating, and how we would manage her kidney disease--the prognosis seemed good.

Since our vet clinic is not an emergency facility, and no doctor is present on the weekend, I got a call from the vet Friday a week ago, suggesting I take her home and provide hands-on care Saturday and Sunday--syringe feeding and subcutaneous fluids--and then bring her in Monday to restart the IV. Sounded like a plan--I was going to attend the Western Washington Wildlife Rehabilitators conference at the UW Saturday, but I could be a little late to that, np--so that's how we proceeded. I picked up Izzy, subq-fluided her, and then left for the conference. When I got back that evening, we did the same routine plus a syringe feeding.

Sunday, same deal. That's when she decided she'd had enough of this crap, and bit me in the right index finger knuckle, HARD! I think I'm going to have a scar from it.

By Monday morning, it was red, hot, and so swollen it had that Botox look: no natural wrinkles anymore; half of the back of my hand was almost perfectly flat and fluid-filled. And it hurt like a bastard! We're uninsured at the moment, due to unemployment, so I don't routinely go to the doctor, but I wasn't about to let this infection go systemic, either, so it was off to the emergency room for me.

I dropped Izzy off at the vet's on the way to the ER, and warned them about her biting me. We actually have observed this behavior, called "The Cobra", in the past: when she feels bad and over-interfered with, she bites swiftly and hard, without warning, compared to the absolute lovecat she always is when she feels better. Since she gives no warning, I didn't want anyone else taken by surprise.

The visit to the Overlake ER was the best it could be, given the circumstances--it's an ER, after all, nobody's idea of a good time (I hope!). But the staff was competent and kind, and since no gunshot wounds or anything like that were coming in, I was able to be seen right away. The nurse practitioner who saw me was friendly and patient, and willing to answer questions. She thought it was a Bordetella infection, and although penicillin is the first line against that infection, the almost-fact that I am allergic to penicillin made doxycycline the recommended way to go.



Figure 1: Image of Bordetella bronchiseptica from http://upload.wikimedia.org/wikipedia/commons/thumb/1/1d/Bordetella_bronchiseptica_02.jpg/240px-Bordetella_bronchiseptica_02.jpg



Figure 2: Doxycycline, related to tetracycline

With a sling to immobilize my dominant hand (to remind me not to use it anymore than necessary), and a container of antibiotics, I headed home. I had just gotten settled in when the phone rang. It was the vet, and she asked me some questions about the bite. Then she said she had some bad news, and I knew before she told me that Isadora had died.

We're all shocked--we thought she was getting over this upper respiratory thing, and would go on to have her kidney disease successfully managed. She thought so, I thought so, Iain thought so--but whatever it was she had, it was too much for her.

Well, that was bad enough. But wait, there's more!

It turns out that King County has a "rabies protocol" that automatically kicks in when an animal bites a human, and then dies shortly after. She had to report it to the public health department, and was waiting to hear back from them whether they needed to get Izzy's head to test the brain for rabies.

She did the right thing in invoking the protocol, even though I'm (almost) sure we're in the clear. I'm just neurotic enough to worry about the tiny possibility of it, even though we agree she showed no signs of rabies either here or at the clinic, and her staggering was plausibly due to her weakness in not eating for so long, rather than the neurological degeneration of rabies. Her "flu-like symptoms" are more consistent with an upper-respiratory-tract infection than the symptoms Wikipedia's entry on rabies describes, and the bite was far from unprovoked. I was bugging her with syringes and needles, and "The Cobra" goes back for years now.

It looks like the public health department is going to agree with us, and not insist on testing. So that's that, except for the next couple of years, in my more paranoid moments, I guess I'll be interpreting every little sneeze or shiver as the onset of my own personal rabies case.

I told a conservationist friend, and said that, just in case, I was preparing a list of people to bite </oldjoke>. "Facultative rabies", she proposed. I like that.

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3 rules for infection control, applied

Son of a bitch, Isadora, that hurt! Twice--once when I was on the receiving end of a deep bite after fluids/feeding, and again when I poured alcohol over it.

Fortunately, I'm current on my tetanus booster shots, given how often I get bitten, scratched, or otherwise punctured around here.

Yesterday, I saw Dr. John Huckabee's talk on infection control at the WARA conference; I thought, though, I'd have a few more days before actually applying them.

Rule 1--Don't be a fomite! Fomites are inanimate objects that can transmit infection, so reusing needles or gloves that can carry germs, or not cleaning telephones, keyboards, or doorknobs that are handled frequently can pass on infection. By "don't be a fomite", he means take care to clean and disinfect your clothing, instruments, and environment in such a way that their potential for passing on infection is minimized.

Rule 2--Wash your hands! I'm pretty good on this one, actually; I wash my hands frequently, especially after handling the cats, or going to the bathroom, and before handling food.

Rule 3--Clean first, then disinfect. This is the one that I've been the sloppiest about in the past, partly because I've never thought too much about the difference between cleaning and disinfection. As Huckabee clarified yesterday, cleaning uses friction to remove microbes from the environment, while disinfection is the use of agents that actually kill microbes (I am deliberately not linking to Wikipedia in this instance because their article confuses the two; I am not the expert who needs to clean it up, but they conflate cleaning and disinfection).

What I've done in the past is pour alcohol over the bite, thinking I was cleaning and disinfecting simultaneously. Wrong! The presence of organic material reduces disinfectant activity; that's what Huckabee means by "clean first, then disinfect". So this time, I washed the wound well, scrubbing and rinsing for an entire minute, before pouring alcohol on it, and then drying it, applying Neosporin, and bandaging.

UPDATE: Ooops, hit "Post" too fast--I meant to say that I hope the fact that Isadora has the strength to deliver a bite like that means she's feeling better, at least a little...

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Isadora update

Isadora's bloodwork is in, and the results are mostly good. The only exceptions are in the complete blood count (CBC): slightly-elevated white blood cells, and slight anemia (low red blood cell [RBC] count).

She tested negative on all the viruses she was tested for--feline leukemia, feline infectious peritonitis, and feline immunodeficiency virus.

Ruling out those viruses ruled out some of the potential causes behind the elevated WBCs--there still may be some inflammatory or infectious process going on that was not tested for, however. One thing that could have happened is that the ear infection has burst through the ear drum, and is now in the middle and inner ear. So we'll continue to treat her with systemic antibiotics, as well as topical, to address that--the cauliflower ear is so deformed and full of cysts that the vet cannot see down into it, and I can't get the eardrops in very far at all.

But even if that explains the elevated WBCs, it does not explain the anemia. The vet explained that anemias can be classified as regenerative or non-regenerative, referring to the presence of immature RBCs, indicating that the body is making up the anemia by creating new RBCs. Regenerative anemia causes include such things as acute blood loss, for example, which the body responds to by upping the production of new blood cells.

Isadora's anemia is non-regenerative, and for the moment, we do not know what's causing it. We hope that the X-rays Tuesday shed more light on what's going on in her abdomen--for example, is the liver behind both the anemia and suspected fluid in her abdomen?

I hope we have some info soon, but in the meantime, she is definitely feeling better after the antibiotic injection, the lysine for the weepy eyes, and the ear drops. She's talkier and more active, pretty much as soon as we got back from the vet. However, I dread the battle of wills that the twice-daily ear drops became last time, and now doubt will develop into again. Oh, well, as the human, I get to suck it up, because it clearly helps her feel better.

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The bats and the bees

Another mystery die-off has begun:

A mysterious malady is killing thousands of hibernating bats in New York and Vermont, with yet another outbreak reported in a Massachusetts mine. Scientists are working desperately to unravel the cause. The disease is called “white-nose syndrome,” because a fungus appears around the muzzle of some affected bats. Researchers do not know whether the fungus is causing or contributing to the deaths or is merely a symptom of another problem.

Bat Conservation International has established a fund that is accepting donations to help finance this critical research. BCI is working with the U.S. Fish and Wildlife Service (USFWS) and other agencies to help find solutions to this critical problem.

Like the bees, the bats are an integral part of our ecosystem, no less for being mostly unseen. I wonder how this die-off is going to affect things, and if we'll notice it here as much as back East.

Colony collapse disorder (CCD) is the descriptive name given to the disappearance of bees all across North America at least, and possibly related disappearances world-wide, observed since late 2006. There is some evidence that it may be related to Israel acute paralytic virus, but as far as I know, that is still speculative. So CCD is really just a name, not an explanation.

My friend Emma, who is very generous with donating the fruit from her garden for a number of projects, observed in early 2007 that she thought it would be a poor year for her fruit trees, due to the lack of bees. Her prediction was borne out--when Terry and I came over to collect fruit for jam for the Medicine Wheel Society Elders' Dinner, there was barely one tree-full of ripe plums the entire season. By contrast, the year before, we had gone back many times and filled up buckets, boxes, and bags (hey, alliteration!). At Terry's, we had made over 100 jars of plum jam; Emma had made her own batch of jam, too; we had eaten plums all summer long; and we had packed boxes of plums to donate to the zoo, where the sun bears and gorillas had feasted on them. Even at that, we couldn't keep up with the plum tree's fecundity--the very last time we went over there to get plums for the bears, fruit had fallen off the tree and was beginning to spoil underneath. We decided it was no favor to the bear keeper to bring in fruit that might get the bears drunk and give them diarrhea, so we missed out on the last batch because we simply couldn't keep up with the tree.

While this anecdote has a severe n of 1 problem, of course, it was consistent with what we know about the bees' role in pollinating fruit. So it will be very interesting to see what happens this year, both with the bees and with the fruit. I think I won't explicitly seek out bee news before the plum harvest, just in order to not bias my observations about the quantity of the fruit.

With the bats, I don't know how the effects of a die-off would show up--more insects, maybe?

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