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Beware of Dog (Bite)

When the Experts Are Wrong

A Blue Christmas in London

Frivolous Use of Antibiotics Can Be Dangerous

Putting Up a Good Fight


March 23, 2001
Beware of Dog (Bite)

first letter i was at a business dinner when I got the call from my wife, Julie. Her voice was high-pitched and strained. "We've had a little accident -- we're going to the emergency room with Hannah," she said. "She was bitten in the face by Tommy." Tommy is our neighbor's dog. I could tell by the tension in Julie's voice that she was in the presence of our neighbors and was trying not to reveal her panic.

Jack, the dog's owner, came to pick me up at the restaurant and brought me to the emergency room, where Julie was waiting with all three of our children. Jack explained that Hannah and his daughter were lying on the floor watching television when Tommy bit Hannah. The attack, apparently, was unprovoked.

Having spent my share of time working in emergency rooms, I felt qualified to make at least a brief assessment of the injury. Hannah was frightened and did not want to take the cloth off her face. When I finally got a look, I was relieved to see just a few puncture wounds on her cheek, ear, temple, and neck. It didn't look incredibly serious, but I was concerned about her pain and worried that the bite wounds might get infected. I sent everyone home and waited with Hannah.

As the hours passed in the waiting room, Hannah's cheek became massively swollen. When the doctor finally saw her, I insisted on a plastic surgery consultation.

The plastic surgeon thoroughly examined Hannah's puncture wounds and determined that there was severely torn tissue beneath them. Julie came back to the hospital, and we comforted Hannah during the surgical repair. When we got home, Hannah's swelling worsened, and she was placed on antibiotics to avoid possible infection.

"Dog bites man" in the news again

Dog attacks can do serious harm to humans, as has recently been reported in the national news. Earlier this year, Diane Whipple was killed by a mastiff crossbreed as she was attempting to enter her home, in San Francisco. The dog belonged to her neighbors. In the same month, in Santa Ana, California, a rottweiler-pit bull mix injured a woman. Also in California, a pit bull bit three students on a middle-school playground. These and other stories are bringing national attention to the issue of dog attacks. Tips on prevention for potential victims and dog owners are being distributed by the American Veterinary Medical Association (AVMA). The Humane Society of the United States is also sponsoring National Dog Bite Prevention Week (May 20-26) to bring more attention to this issue.

What happened to Hannah occurs approximately 4.7 million times a year, according to the AVMA. Around 60 percent of dog bite victims are children, and the dog is often either a family pet or a neighborhood dog well-known to the victim. Parents should be aware that any bite that breaks the skin deserves medical attention, no matter how innocent it appears. All dog bites are potentially serious and can result in structural damage to nerves, tendons, and blood vessels below the skin.


Parents should be aware that any bite that breaks the skin deserves medical attention, no matter how innocent it appears.


Parents should also be careful to watch the wound and make sure it is healing properly: Up to 20 percent of all dog bites become infected. In Hannah's case, Julie and I were worried about possible nerve damage because our daughter's speech was affected, as was her smile. Once the swelling subsided, her muscle and speech function returned to normal, although she does have some facial scarring.

Tips to avoid a dog attack

Since the attack on Hannah, Julie and I have tried to teach all our kids how to behave around dogs to prevent future injury. If you are approached by a dog, these tips from the AVMA may reduce your chances of being attacked:

  • Don't run away.
  • Stay still until the dog leaves, or back away slowly until the dog is out of sight.
  • Avoid eye contact. Remain calm. Dogs may view staring as aggressive.
  • If you fall to the ground or are knocked down, curl into a ball, placing your hands over your head and neck. Protect your face.
  • Never approach an unfamiliar dog.
  • Stay still when an unfamiliar dog comes up to you.
  • Never disturb a dog that is sleeping, eating, or caring for puppies.
  • Do not pet a dog without letting it see and sniff you first.
  • Do not ride your bicycle or run past a loose dog.
  • Do not tease a dog, pull its ears or tail, or squeeze it too hard.

It is important that young children never be left unsupervised with a dog. Owners are ultimately responsible for training and securing their dog; failure to do so may result not only in physical injury, but also in civil (and possibly even criminal) penalties. According to State Farm Insurance, dog attacks cost $1 billion annually, and insurance companies paid $250 million for dog bite liability claims in 1996 alone.

What can a dog owner do?

The AVMA and State Farm Insurance teamed up to determine the following guidelines for dog owners to prevent attacks by their animals:

  • Carefully consider your pet selection. Before and after selection, a veterinarian is the best source for information about behavior and suitability.
  • Make sure your pet is socialized as a puppy. This will help your dog feel at ease around people and other animals. Expose your puppy to a variety of situations a little at a time and under controlled circumstances. Continue exposure on a regular basis as your dog gets older. If you're not sure how your dog will react in a large crowd or on a busy street, be cautious. Don't put your dog in a situation in which it feels threatened or teased.
  • Train your dog. The basic commands sit, stay, no, and come can be incorporated into fun activities that build a bond of obedience and trust between pets and people. Don't play aggressive games, like wrestling or tug-of-war, with your dog.
  • Keep your dog healthy. Have your dog vaccinated against rabies and preventable infectious diseases. Parasite control plays an important part in your dog's mood and behavior.
  • Spay or neuter your pet. Spayed and neutered dogs are less likely to bite.
  • License your dog with the community as required.
  • Obey leash laws.
  • Be alert. Know your dog. Besides being alert to signs of illness, but you must also watch for signs your dog is uncomfortable or is feeling aggressive.

Hannah is a brave and resilient little girl. Last week she underwent laser surgery treatment in an attempt to minimize the scarring on her face. So far, it's hard to tell what the long-term effects of the injury will be. She wears her injury like badge of courage at school, and her love of dogs does not appear to be diminished. I still cringe every time I think about what could have happened to her. The worst part is knowing the attack was totally preventable.

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 J. Kevin Shushtari, M.D., is's Chief Medical Officer and a co-founder of the company. He is also a board-certified internist with a medical degree from Dartmouth College. In Dr. Kevin's Column he will share his own experiences as a physician, a family member, and a patient.