A Cautionary Tale

My wife Chris has a friend here in town who has had a very rough month.

Her friend Lisa was bitten on the thumb by her cat, Peaches, on March 13th. She was trying to give Peaches an antibiotic pill at the time and didn't even think that the bite had broken the skin. It had, it turns out, punctured the thumb nail.

Usually cat bites or scratches are not that serious especially if you clean the wound quickly with soap and water. In up to 50% of the cases, a minor infection ensues and in some people, like Lisa, it can become a nightmare.

About a week after the bite Lisa's thumb became a little swollen and red. At the time she didn't even associate this with the bite and when she came down with fever and chills about three days later she thought she had the flu. When the lymph node in her armpit began to swell, she thought she had pulled a muscle. Shortly after that, she went in for her first of three visits to a local urgent care facility.

By this time, the thumb was more swollen and the association with the bite had been made. They gave Lisa antibiotics and told her to soak her thumb in Epsom salts to help with the swelling.

By the time Lisa got in to see her regular physician, the bone in the thumb was involved and he sent her to an orthopedic surgeon. She was in surgery the next day. 

Since then she has had three separate surgeries and is in a cast. She has spent ten of the last fourteen days in the hospital. An infectious disease specialist was called in and she has a surgically implanted intra venous port for heavy duty intravenous antibiotics which she will be taking for nine weeks. She may lose part of her thumb.

And if you think that things can't get any worse,  Peaches, her thirteen year old cat, died of pneumonia complicated by a bad reaction to ketamine, a drug her veterinarian had originally given as an anesthetic to facilitate some diagnostic tests.

So what happened?

Cat bites are by definition puncture wounds because cat teeth are very sharp. Think of them as bacteria injection devices and you start to get an idea about how they can be so serious. The surface wound may look like it's healing but the injected bacteria deep in the tissue are silently multiplying in a warm cozy place.

Bites to the hand or fingers can be more serious too because as extremities they don't have the greatest blood supply in the world. The poor circulation makes it difficult for antibiotics to reach the site via the blood stream in a concentration that will kill the bacteria. Once the infection gets into tissues with even worse blood supply like ligaments, tendons or bone, it gets even more difficult to manage.

The multiplying bacteria set off a chain reaction of inflammation, swelling, and infection that leads to fever, chills and swollen lymph nodes. The bacteria can spread through the body via the bloodstream; a condition called bacteremia. In fact, Lisa's bug, is the same bug that can spread to the heart at the time of a teeth cleaning leading to valvular endocarditis.

It looks like Lisa is going to be OK. Fortunately they have health insurance, although her husband David tells me it's not the greatest health insurance in the world. Being self employed, they, like most of us in the same situation, choose "affordable" health plans with high deductibles. So their medical bills are still pretty high. (Too bad David and Lisa aren't elected officials. I understand they have great health care.)

Lisa and David asked me to remind pet owners of a couple of things. First of all they love their cats and they still have two at home. The other thing they said was, "spread the word". If you get bit or scratched by your cat, take it very seriously. Wash the affected area thoroughly. If you get the slightest swelling or redness get in to see your physician asap. If you are immuno suppressed for any reason see your doctor immediately. This article can provide more helpful information.

Good luck Lisa, we'll be checking in on you.

Comments

[Lindsay]

Yikes! I'm glad Lisa is doing OK. I'll remember to wash my hand if my cat ever bites me.