HealthLeader

An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Beware of Dog

Dog attacks on children can leave deep physical, emotional scars

Beware of Dog

Dolores Govea was just starting dinner on a January afternoon when her 5-year-old daughter rushed into the house crying so hard that Govea could barely understand her.

“The dog got my sister,” she managed to choke out.

Govea ran out the door just in time to see her teenage daughter fighting a dog off Janelle Govea, 6.

“When I saw her face, it was terrible,” Govea remembers, her voice trembling. “And Janelle said, ‘Don’t cry Momma. The dog didn’t do anything to me.’ She didn’t realize how bad it was. She was in shock.”

The unsecured neighbor’s dog attacked Janelle as she exited a school bus in Montgomery County (Texas). The dog’s teeth sliced her skin in long gashes from her neck and mouth to her ears. One eyelid was lacerated and her scalp was torn open to the bone.   

The American Veterinary Medical Association says dog attacks are the most commonly reported childhood public health problem in the country. Each year, 4.7 million Americans are bitten by dogs and 800,000 seek medical attention, according to the U.S. Centers for Disease Control and Prevention. Of those injured, 386,000 are treated in emergency centers and 16 die. Children ages 5 to 9 are more likely to be victims of dog bites. The cost in pain, medical bills and insurance is high. The Insurance Information Institute estimated that nearly $479 million in dog bite claims were paid by all insurance companies in 2011.

Houston was third in the United States Postal Service’s 2011 Top Dog Attack Rankings with 47 attacks on mail carriers. At Memorial Hermann-Texas Medical Center and Children’s Memorial Hermann in Houston, the number of people like Janelle admitted to the hospital with bite injuries increased from 42 in 2010 to 50 in 2011; adults (age 16 and above) increased from 13 to 18 and children (age 15 and below) increased from 29 to 32. Those figures don’t include people who are treated and released.

“We have a problem. Janelle represents our kids and our kids deserve a safe environment,” says James Wilson, DDS, professor and vice chairman of the Department of Oral and Maxillofacial Surgery at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry and director of the Oral and Maxillofacial Trauma Service at Memorial Hermann-TMC. “The impact on health care alone is tremendous. You’re looking at multiple surgeries and thousands and thousands of dollars.”

Janelle was transported by Life Flight to Children’s Memorial Hermann Hospital, where she was met by a team of emergency center personnel and the UTHealth School of Dentistry oral & maxillofacial resident on call. On this particular night, Kamal Busaidy, DDS, associate professor of oral and maxillofacial surgery, and Simon Young, DDS, PhD, MD, a resident, arrived to assess the damage. The swaths of tissue left exposed by the gashes were covered in grass and dirt, and her scalp was torn in numerous places.

“Animal bites cause a lot of tearing and are susceptible to bacterial infection,” Wilson says. “We have to check for damage to structures including the nose, eyes and ears. Sometimes a dog’s teeth can go through the skull. Janelle was sliced open, but fortunately, there were no skeletal fractures.”

After cleaning and irrigating the bite wounds, surgeons open and probe the wounds and remove any tissue that is too badly damaged. “And then we put the puzzle back together,” Wilson says.

Janelle’s first surgery took eight hours. She returned multiple times for cleaning and debridement of the wounds. In eight or nine months, she’ll return for further assessment and revision of scarring.

“We want to wait and let the tissue settle down,” says Wilson. “If we do a revision early on, we won’t get as good of an effect.”

Hidden scars

Janelle has some lingering vision problems in her right eye, but her skin is mending and her hair, once long, is beginning to grow back. But there are other unseen injuries.

“I know she’s not going to be the same,” says her mom. “Sometimes she’s sad. She was never sad before.”

“Dog bites are very scary injuries for the people involved. It’s an episode of violence,” says James McCarthy, associate professor of emergency medicine at UTHealth Medical School. “They experience the turmoil of emotions because often the attack is by a pet or a friend’s pet and is unexpected.

Wilson and McCarthy were surprised to learn that a dog that injures someone severely is not automatically euthanized (put to sleep) if it’s the first assault, according to state law. Between days spent in the hospital and follow-up appointments, Govea had to file an affidavit and appear in court to ask that the dog be euthanized after the owner refused to do it voluntarily.   

“It’s very frustrating,” Wilson says. “Her mother had a lot of anxiety after hearing that the dog was going to be released back into that home and the yard where they get off the bus.”

The dog was eventually euthanized.

“As severe as her injuries were, she was fortunate to come to a place like Memorial Hermann-TMC that has the services and resources to manage these acute injuries. It is gratifying to see the buoyancy and determined spirit within her and her family,” Wilson says. “Unfortunately, she won’t be our last dog bite this month.”

For more on Janelle’s story, watch this report from KTRK-13 in Houston.