posted
My husband got scratched by a piece of rusty metal at work today and hasn't had a tetanus booster since '86. I told him he would need to get one right away and we called his doctor. The woman that made the appointment said that they couldn't see him until tomorrow afternoon, which will be over thirty hours after Jes got scratched.
I guess I thought that it would be a little more urgent than that. Is thirty hours too long to wait to get a tetanus booster after a potential threat?
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posted
High fever and incoherence would be a sign to go to the emergency room. He probably shouldn't take any OTC medicine that would mask symptoms while you are waiting. And I would get the name and rank etc/ of the lady who set your appointment, just in case.
Posts: 11017 | Registered: Apr 2003
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The scratch is red and appears to be a bit puffier than normal. No spider-web lines yet, but Jes said that the area looks "weird". He described it as looking like smeared blood, except under the skin, and it's about half a centimetre in width. Keep in mind this was a pretty tame little scratch before.
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PSI, call back and talk to your physician's nurse (not just the receptionist), please. Tell them a doctor you know said to, if it helps. I would hate to criticize another pratice with only limited details, but the booster is supposed to be given on the day of injury if the last booster was >10 yrs ago, or if the wound is severe and the shot less than 5 yrs ago. Your husband fits the criteria.
There usually aren't any symptoms for the first week. After that, sore throat and trouble swallowing, sometimes with local rigidity before it spreads. Your husband will likely be fine -- on the rare chance that he isn't though, the wait of thirty hours means that more toxin gets to develop, and the damage to nerve cells done by the toxin cannot be reversed (you just have to wait to grow more nerve cell axons). There have been cases of toxin going to the spinal cord in 2 days, although again, this is vanishingly rare.
But why take the chance? The person who made the appointment is not likely to be medically trained, and they are looking for a doctor slot. Frankly, a nurse could do the booster shot and eyeball the wound, and they wouldn't have to book a doctor visit.
Explain what happened to the nurse, include the rusty part and the 1986 part and the "funny-looking" part, and if they cannot at least get you in for a booster, I'd ask where you should go (urgent care clinic if they have one affiliated or ER if not). Please do post back here. I will be worrying about you.
[Edit: I'd be sure to let them know about the delay via the front desk, too.]
[ September 28, 2004, 07:50 AM: Message edited by: Sara Sasse ]
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I just wanted to add that I'm allergic to tetanus toxin - when I got a tetanus booster for an injury I broke out in hives and had immediate swelling in the arm where I got the shot.
Mack - does that mean if I ever get scratched by a rusty nail my arm will definitely fall off?
I'm scared.
Seriously, I hope your hubby's ok. Posts: 14428 | Registered: Aug 2001
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Sara, darling, you know I love you to pieces, but really - asking me if I remember something?
I have trouble remembering where all four of my kids are supposed to be on any one day.
*looks frantically to see if she's missed some type of appointment*
You know what's weird - my husband is allergic to tetanus toxin too. How strange is that? And I'd had tetanus shots before I married him and didn't react. Can you catch allergic reactions from people?
Actually, I've had a bunch of allergic reactions over the last five years that I never had before. I've been stung by bees or wasps and reacted, and I know that as a kid I'd been stung loads of times with no trouble at all. I had that reaction to the flu shot - three reactions, each one progressively worse than the other until a doctor told me never to get one again.
Can one grow into allergies? Or is it some freak of my immune system?
(PSI, I am sorry if I'm hijacking your thread - I too, hope your husband is doing better that sounds like a scary wound. Especially since I've just recently been through all that with my cousin, I'm particulary sensitive to the idea of bacterial infections now.)
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Belle, you can be passively immunized with tetanus immunoglobulin. This is a blood-derived product, though, so it has its own risks. It is also quite expensive. However, it consists of antibodies to tetanus (not the tetanus proteins themselves). And oral metronidazole (aka flagyl) is in the process of replacing the intramuscular shot of penicillin by now (studies show it is more effective).
Any allergic reaction to the booster shot ["Td"] is likely to the diptheria antigen in the tetanus booster, not the tetanus toxoid (the diptheria part is more allergenic), so giving just the tetanus toxoid part -- which is what we do for pregnant women -- should be considered.
This is worth remembering, as who knows whether an intern in a boondocks ER will have worked with someone presenting with an allergy to the tetanus booster.
[ September 28, 2004, 11:03 AM: Message edited by: Sara Sasse ]
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Will save that post and file it away for future reference. Might come in very handy someday, especially for my hubby, who is also allergic to the shots and who is on construction sites a lot. His chances of getting scratched by rusty metal are a lot higher than mine.
What would we do without you? You are a true hatrack angel.
Posts: 14428 | Registered: Aug 2001
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Just knowing that "there is something else you can do" might well be enough. The persons caring for you could always call a hospital pharmacist for more details.
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I think you nailed it when you said that it was in bad taste Trevor.
Yes, I'll admit, that was a bit weak, but you'll have to forgive me; that was my first pun this week, and I'm afraid I'm a little rusty.
Posts: 16059 | Registered: Aug 2000
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Well, I'm back. My husband's already at work and there's no chance he'll leave early so he'll just be going to the scheduled appointment. The good news is that the scratch looked a good deal better this morning.
I'm annoyed that he won't leave to go get the shot early, but the receptionist that made the appointment said that the doctor would want to examine him, so...? As far as I know I've never actually seen a nurse there...it's a small practice with one doctor and the people that put patients back.
I wish I had seen this earlier but my electricity has been off and on and it's only just recently started behaving enough for me to get online. Thanks for all the info, Sara. Sadly my husband is too hardheaded to heed it.
But hopefully things will be okay. I know for sure that if he does get something despite his booster, I will be complaining about it to someone. Shouldn't the receptionists be trained in what types of things need to be seen immediately?
I really should just trust my instincts. : )
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Not really - receptionists are glorified secretaries. At no point should they ever, ever presume to dispense medical advice because they have no training in it.
And please note, I'm not bashing secretaries or receptionists - I'm simply pointing out the limitations of the job.
As for your hubby, men no longer get to be macho when they have kids. Just my two bits.
posted
Again, probably not. I suspect she simply handles the day-to-day paperwork necessary to make the office run. For her to modify your hubby's appointment time because of the nature of the injury would require her to evaluate it in some fashion or form.
As for being a workaholic, I'll give him that one.
posted
I just wonder because I know when you make appointments with the peds the appointment makers always know to admit you right away if the child is a certain age, or has a certain fever, or whatever. I know it's because infants are more of an emergency when things go wrong, but you'd think there'd be a big list of "emergencies" like being bitten by a rabid dog or something that the receptionists would have on hand when making appointments.
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The next time you take your child into see the pediatrician, ask. For that matter, call the doctor and ask - it may very well be she is supposed to know better and didn't act accordingly.
Every time I went, there was a nurse either behind the window or within arm's reach to answer any questions.
quote:Sara, darling, you know I love you to pieces, but really - asking me if I remember something?
*snort* And there we go, soda all over my laptop screen.
Yes, the arm may fall off, but it can be successfully reattached with full function and nary a hint of it ever being separated from your body...all by the hatrack docs.
The miracles of modern Racking! Posts: 14745 | Registered: Dec 1999
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PSI, the odds are definitely in your husband's favor, absolutely. Were I to put money on it, I'd be betting on his survival without much qualm.
I would, however, ask him to bring it up with his physician, just to see what someone else's opinion is. I wouldn't be as interested in whether your husband is likely to be okay (we all know that's the case), but when the physician would have ideally wanted to see that injury (rusty metal, no tetanus booster) -- i.e., if a similar circumstance arises, what should you do? Take the appointment, ask to speak to him, go to an urgent care clinic, go to the ER?
That's the information that will help you in the future.
[ September 28, 2004, 01:49 PM: Message edited by: Sara Sasse ]
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Receptionists are not necessarily glorified secretaries, though they do tend to be better looking. It is possible to instruct a layperson to prioritize appointments based on certain parameters (as you mention with the pediatrician) but in general, you can't count of the office staff. It could be a temp, for all you know.
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Belle - Yes, it is possible to develop various allergies as an adult, since allergic reactions are a reaction of your body's immune system. The development of multiple, serious alleriges (in my experience) as an adult occurs in conjunction with autoimmune disorders. I also know that what may have been mild allergies can become serious at some unknown time (as my allergist once explained it to me - your body can handle some unknown number of exposures to a mild allergan before it starts reacting severely to it - the bad thing being that you can't know ahead of time where that point lies). Another interesting thing is that is it possible for children to "grow out" of allergies (with the exception of food allergies).
posted
The last time I stepped on a rusty nail, I called the health info line and they told me not to worry and just wash the cut with soap and warm water for about 10 minutes.
Nothing ever came of it, unless my entire life since then has been a tetanus-induced delerium. Posts: 1996 | Registered: Feb 2004
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1) ask about your immunizations, or 2) ask about your last tetanus shot, or 3) already know your immunization history because you were calling your own doctor's office (or someone at a clinic that shared medical documents)?
Rust won't hurt you. It can be rusty all it wants, so long as it doesn't have Tetanus bacteria on it. The bacteria are in the soil. Sometimes rust is an indicator of dirtiness, unlike "clean shininess," but the rust itself is irrelevant.
Tetanus bacteria that live in the dirt won't hurt you if you've been vaccinated against them. They are also highly unlikely to hurt you through a "scratch," because they are anaerobic bacteria and oxygen kills them, essentially. If the cut goes deeper than a scratch -- especially if it is a puncture wound -- then the bacteria (which are ubiquitous in the soil) can be placed deep enough to colonize and grow.
Now, if you were vaccinated, this part would not be a problem. If you were not, this would be a gambling situation, betting on
1) whether there were tetanus bacteria in that particular sample 2) whether they were placed far enough away from oxygen 3) whether your system would catch them soon enough and wipe them all out before reproduction hit its reproductive curve
If you lose, the bacteria produce two kinds of toxins, one which is pretty harmless and one which causes muscles to go into tetany (unbreakable spasms), travelling up the nerves throughout the body. Sometimes this kills you, sometimes it can be halted early, sometimes you can ride it out on life support.
I understand the desire to be "above all that" sissy worrying about things. It's nice to feel invulnerable.
If you have loved ones, I personally think it's about as mature and responsible as playing dodge ball in traffic, but then again, some people need the power trip. Or get a high from the gamble. Or don't really care what happens to them, or whatever. I do it too -- I'm a sucky patient. [I am. I'm always working on it now, because I owe it to those who love me and depend on me. I finally got it: "it isn't always all about me." ]
But as for my professional advice, there are many things which I try to calm people down about (high fevers, sprains, hearing your heartbeat throb in your ears while trying to fall asleep), but this isn't one of them. *shrug It's a gamble, and I don't think it's worth it.
[ September 29, 2004, 08:46 AM: Message edited by: Sara Sasse ]
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that's interesting about the autoimmune disorders...there's some belief that endometriosis might be an autoimmune disorder and I certainly have/had it. I also have quite the family history of autoimmune disorders, esp. rheumatoid arthritis.
Posts: 14428 | Registered: Aug 2001
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After scaring the crap out of my husband with stories about how painful tetanus shots are and the giant bruises I got after each one, I found his old shot records that show he's had a tetanus shot since the one in 1986. So one hour before the appointment I let him off the hook and cancelled it.
posted
It was in '97. If it had been an actual cut he probably would have needed another shot. But it was just a scratch. : )
Posts: 6367 | Registered: Aug 2003
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Last shot in '97? You're at 5 years. I probably would have still made him see the doctor and let them decide if he should have another booster to be safe.
That reminds me, I should get my booster sometime soon. Maybe my gyne's office can do this so I don't have to set up two different appointments with two different people...
posted
Goody I just called my gyne up, since I have an appointment next week, had a not so good result on a papsmear 6 months ago so they want to re-check now. They don't do tetanus shots.
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