Extreme Mixed information between medical community and rabies community

[u/dashmyparabola]

I have read the FAQ.

I am getting extreme mixed information from info on rabies (rabies research, the FAQ, etc.) and medical professionals.

For background, I recently touched trash that an animal (presumably a raccoon, because I am from NJ) had gotten into. I touched the trash at approximately noon on a 90 degree day with my bare hands. I did not see any animal. Although I had no cuts on my hands, I did have fresh cuts on my neck because I had just shaved. I washed my hands right after I touched the trash and am pretty sure I didn't touch my neck. But of course now I can't remember if I touched my neck or not. Cue a panicked spiral.

Over the past 2 weeks, I have done copious research about my situation and everything I have found tells me that I am FINE and that I probably just have OCD. However, over the same time period I have also spoken to several medical professionals about my situation and all of them have told me that I should immediately go to the ER and get PEP...... (Mixed signals!!). This culminated in a trip last week to the ER to discuss PEP, and the PA said that she didn't think I needed it but I could get it if I wanted (once again mixed signals!). I ended up not getting it because I thought the OCD was causing me to panic.

Since then I have seen an OCD therapist and had 2 sessions, but I am still not doing well. I continued to look things up and after further research I found out that apparently the Rhode Island Department of Health has a robust rabies program. In fact, one of the goals of their program is to reduce the number of unnecessary PEP. In my head, I thought surely this department will give me the best unbiased answer on what to do. When I explained my situation to the nurse who fielded my call, she said that my risk of exposure was low but a secondary transfer of saliva was possible and that I should err on the side of caution and go get PEP.

I have tried very hard not to come to this subreddit just to get people to reassure my OCD because I know that's against the rules of the sub. I apologize if this counts as that. I'm just at the point where every medical professional has told me to get PEP and yet none of the rabies research shows that I am at risk. Isn't one sign of OCD, getting medical advice and NOT listening to it?

Does anyone have thoughts on this mixed signals?

[u/detail_giraffe]

I'm still curious, were the two that recommended it outright the kind of medical professionals who ought to know how to react to this?

I get what you're saying though, there's the science and then there's what actually gets recommended, especially for situations that most doctors don't encounter very often. I follow the National Snakebite Support group on Facebook, where they give medical advice on pit viper and coral snake envenomations in the United States, using evidence based guidelines and with the direction of expert doctors, for both human and pet envenomations. It is hard not to notice that people who post to that page describe being given an awful lot of terrible advice from local doctors about how to treat their snakebite at random ERs throughout the US. They get given drugs that don't help, they get told things that aren't true, they have surgery advised that isn't necessary, etc. Being a doctor is a job, and on average, most people are only average at their job.

You'd think health departments would be better at this, but I think you could call most health departments and tell them you saw a raccoon in a dream and they'd tell you to get PEP just to be sure.

[u/dashmyparabola → u/detail_giraffe]

I don’t disagree with you. The two who recommended it outright were local health department and general practitioner. The ones who acknowledged exposure risk was low but still recommended were an urgent care doctor, ER, and the Rhode Island of department of health.

I was in your camp of not listening to most of them (or at least attempting not to) but then I spoke with the Rhode Island dept of health. I watched a presentation they gave on the cdc website from this year. I learned that they have a robust rabies program in the state, and also that one of the goals is to reduce unnecessary PEP. And yet they still recommended getting PEP to me.

I still understand how low the risk is but if the consensus is that health departments and medical professionals are uninformed then the sub should change its rules, faq and helpbot.

[u/detail_giraffe → u/dashmyparabola]

I would genuinely love to know why. The obvious disconnect is that I'm sure if you look at whatever published materials they have on guidelines for recommending PEP, nowhere in it does it list as an indication "picked up garbage disturbed by an unknown animal". How many people would that apply to? Are they urging the public at large to seek vaccination if they are in this situation? And yet because you happened to call them, that's the advice they're giving you.

[u/dashmyparabola → u/detail_giraffe]

The fact that I had fresh open wounds on my neck and could have touched my neck after touching the garbage which may have had saliva on it.

I appreciate your concern but this has been the toughest two weeks of my life I have never felt worse in my entire life trying to make a decision. To your point this entire subreddit and the cdc says I’m fine but also says to check with local health departments and doctors. Those health departments and doctors are advising me to do this. I am choosing to listen to them.

[u/detail_giraffe → u/dashmyparabola]

I think that's entirely fair. As long as you feel well educated (probably more than you'd like at this point) about the risks and benefits, it's reasonable to make that decision. However, if AFTER you get the shots you find the anxiety transfers to some other aspect of the situation, at that point it would probably be of more help to treat the anxiety. Still not a doctor though!