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Interviewer: Poisonous spider bites, what should you do if you get bitten? That's next on The Scope.

Announcer: This is "From the Frontlines" with emergency room physician, Dr. Troy Madsen on The Scope.

Interviewer: Dr. Madsen, you know, for whatever reason, spiders will instill a bit of fear into a lot of people, right? Nobody wants to get bitten by a spider but realistically, it's just kind of the poisonous ones you have to look out for.

Dr. Madsen: That's right. It is. You know, we often have people come to the ER saying they've been bitten by a spider, they aren't sure if they have but they may have an infection or an abscess. In those cases, honestly, I don't know if they've ever been bitten by one, but you're exactly right. It's really just the poisonous spiders that we really worry about in terms of more serious symptoms and more concerning things.

Interviewer: All right. So a regular spider bite probably nothing to worry about unless you do start seeing an abscess or some infection then you would want to get that treated. But what are we talking about poisonous spiders? I understand there are two essentially in the United States. You've got the brown recluse and you got the black widow.

Dr. Madsen: That's right.

Interviewer: If I get bitten by either one of those, is that a big deal?

Dr. Madsen: Probably not a huge deal. Let's say that right off.

Interviewer: Because I was terrified of black widows as a kid.

Dr. Madsen: Oh, me too. And see, I'm just scared to death of those things, thinking if they bit you, you were going to die.

Interviewer: Yeah, yeah.

Dr. Madsen: That's not the case. I guess we could talk about black widows first because when I think about it as a kid, seeing a black widow spider, when your friends told you they had a black widow spider in the window, well, it was just like, "Wow, stay away. That is just so scary."

Interviewer: That's right.

Dr. Madsen: Impending death. That's not the case. If a black widow spider bites you, it's one of these things where it just makes you feel really miserable and kind of the classic thing is someone may come to the ER and maybe they know they've gotten bitten by a black widow spider, maybe not, but they just have tons of abdominal pain and you push on their abdomen and it's very rigid, almost like something where you would think they had like some sort of a severe infection in their abdomen, but that's classically what it causes. It causes nausea, vomiting. People just feel awful.

It's the sort of thing where I'll give some fluids, some nausea medication. They often require pain medication or something just to calm down their nerves because they're so tense from it. But then it goes away. It might take a couple days, but it's not going to kill you.

Interviewer: So if you're out in the wilderness on your own, you didn't have medical attention, you would feel pretty cruddy for a couple of days.

Dr. Madsen: You would.

Interviewer: That's the biggest. And then dehydration probably the biggest danger.

Dr. Madsen: Exactly.

Interviewer: If you're nauseous and throwing up. Would you throw up from a black widow spider?

Dr. Madsen: Absolutely.

Interviewer: Nauseous. Okay.

Dr. Madsen: Yeah, and it's one of those things it's like let's say you get food poisoning or you get some sort of viral illness. It's the same sort of thing where if you're otherwise healthy, probably not a big deal, you're going to feel awful, but you're going to get over it. But if you have other issues like maybe heart disease, diabetes, issues where you're already maybe having some health issues and then you throw in that dehydration along with it, that could cause some bigger problems, so that might be a reason where you need some medical attention for that.

Interviewer: All right. What about the brown recluse spider? Here in Utah, people say they get bitten by them. This is like the ongoing debate, right?

Dr. Madsen: Yup.

Interviewer: Like one person will say, "Yeah, they're absolutely in Utah." But a lot of other people will say, "No, they're not."

Dr. Madsen: That's right. And from everything I understand they're not in Utah. And I agree. I have people come to the ER who would swear they have been bitten by a brown recluse spider and who knows? I can't say they have or they haven't. Maybe it traveled here on a moving van from Alabama. Who knows? But these are primarily in the Southeastern U.S. We have a spider in Utah called the hobo spider that is brown and looks like a brown recluse spider, so that might cause some confusion. But the hobo spider doesn't cause the problems that the brown recluse causes. And it can maybe cause local infections, some issues there.

But the brown recluse, really the big thing with that is it causes a lot of skin breakdown where it bites. So unlike the black widow that causes a lot more symptoms like nausea, vomiting, a lot of symptoms all through the body, the big issue with these brown recluse bites, and I saw this when I worked back in Ohio, is it causes lots of skin breakdown, but quite honestly, there's not a ton we can do for that. Sometimes, with these areas, you know, you can see an area maybe a few inches wide where it just eats away at the skin, takes several weeks to really see this progress.

Some of these cases, people eventually require a skin graft to treat that area, but it's also one of these things where if you're rush to the ER, maybe we could try on an antibiotic. I mean it's questionable. Is there stuff that really prevents this? I haven't seen anything convincing. But you can try stuff. Maybe it helps, maybe it doesn't.

Interviewer: All right. And again, is it a painful thing so maybe some pain medication would be a good idea and stuff like that?

Dr. Madsen: Yeah, maybe some pain medication, you know. Again, we see lots of people who swear they've been bitten. Who knows if they really have?

Interviewer: All right. So I think we all have already covered the treatment. Brown recluse not necessarily a lot you can do in the short term.

Dr. Madsen: Not right off. I mean, if you're absolutely convinced and you know it's a brown recluse, maybe get checked out, maybe we can try something.

Interviewer: Got you. If you see your skin starting to disintegrate, then you know it wasn't a hobo spider.

Dr. Madsen: That's right.

Interviewer: And then for the black widow, abdominal pain the thing to watch out for there or the thing that you would treat is if there was actually throwing up to make sure that you stay hydrated.

Dr. Madsen: Exactly. Or if you're just in so much pain you can't tolerate it, you may need some pain medication.

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Interviewer: You get bitten by some sort of animal, whether it's a dog or a wild animal, the first thing you probably are starting to worry about is, "Did I get rabies?" We're going to find out more about that next on The Scope.

Dr. Troy Madsen's an emergency room physician at University of Utah Health Care. You get bit by an animal, I think the first thing a lot of people think after, "Ouch," is, "Ooh, do I have rabies?" Is that a real threat?

Dr. Madsen: It's a real concern. So, primarily, you're thinking about this with dog bites, cat bites, raccoons, foxes, and bats. And one of the really interesting about bats is, and this is something I've found kind of fascinating, the Centers for Disease Control, the CDC, actually recommends if you wake up and you look at the ceiling and there's a bat there, they actually recommend getting the rabies vaccine in that situation. The idea being that you may have been bitten by the bat during the night, you may not know you've been bitten, the bite marks are usually so small you can't see them. So the concern is that great.

There are certain animals that you may get bitten by and you may wonder about the concern about rabies, animals like rabbits, rats, mice. Those are not really concerns. The big thing I think about in my mind, typically, the animals that are going to transmit rabies are animals that are not necessarily vegetarian-type animals. So rabbits, those things, they don't really transmit rabies. It's more things like foxes, skunks, raccoons, these kinds of scavenger animals that may be eating some meat here and there. Those kinds of animals are sometimes those that carry rabies and those are the ones we get concerned about in saying, "Hey, if you've been bitten by one of these animals, we probably need to think about rabies."

In terms of dogs and cats, if it's an animal where you don't know the dog or you can't observe it, you don't know if it's had its shots, those are also animals where absolutely we worried about rabies and we treat you potentially to prevent a rabies infection.

Interviewer: So if it's a neighborhood dog, good idea to go talk to that neighbor, get that information and save yourself from the rabies shots, I suppose?

Dr. Madsen: Exactly.

Interviewer: If you find out, no, they haven't had their vaccinations, but they don't seem to be showing any symptoms, or you've been bitten by another animal where you're unsure, what would the next steps be?

Dr. Madsen: Then, that's a situation where you need to get the rabies vaccine. And what that involves, first of all, is giving them a medication at the site of the bite wound to prevent rabies infection. It's not necessarily the vaccine, but it's something that kind of neutralizes the virus if it is there. And then I start them on a series of basically four shots, where they'll come in, they'll get the shot that day, they'll come back in a few more days, get another shot. These are all vaccines to prevent a rabies infection.

And that's a precaution I'm going to take on anyone who comes in after a bite from any animal that could be carrying rabies. And the reason we're very, very cautious in that situation is because there's not much you can do if someone gets rabies. It's something you really want to prevent. You don't want somebody to catch it because if someone catches rabies and they actually develop the disease, it's almost universally fatal.

Interviewer: Really? So it's bad news, it's serious stuff.

Dr. Madsen: It's bad news if you get it, yeah. It's one of those things you can try and treat it and try and get them through it, but it's a horrible thing to get. So really, the treatment for rabies is prevention.

Interviewer: Gotcha. And these shots, they used to be in the stomach, right? And I heard they used to be really painful and there are a lot of them, but you're saying there's one at the site and then four more after that. Where are those four more?

Dr. Madsen: They're just in your arm or your leg. It's not in the stomach. I remember hearing that as a kid as well.

Interviewer: Has that ever been true?

Dr. Madsen: I don't know. That's . . .

Interviewer: Oh. Not since you've been in medicine.

Dr. Madsen: Not in the last 15 years that I've been in the medical profession.

Interviewer: Okay. All right.

Dr. Madsen: I don't know. I heard that too. I remember always hearing that you had to get a shot in the stomach and I thought, "Wow, if I got bitten by a dog, no way would I want to go get the rabies shot because that sounds miserable." But no, these are shots, you give them the same place you'd give a tetanus shot or something like that. They hurt a little bit, kind of like a tetanus shot would, but it's not something, like some really crazy shot that you're getting in your stomach.

Interviewer: Yeah. And better than the alternative.

Dr. Madsen: It's much better than the alternative. Exactly. You don't want to get rabies.

Interviewer: And is this an ER-only thing or could you do an Urgent Care for this?

Dr. Madsen: I think Urgent Cares can do this. I can't say I've looked into it specifically to see if they offer the rabies vaccine in most Urgent Cares, but it's a pretty straightforward thing. If you went there and they just said, "Hey, we don't have the vaccine here," then they're going to send you to the ER, but I think it's a reasonable place to start.

Interviewer: All right. And is there a time limit? After I get bit, is it a day? Six hours? Three hours?

Dr. Madsen: I would want to get in within the first 24 hours. Really, as soon as you can. I would not put it off, especially, like I said, because one of the vaccines, one of the injections we're giving, at the site of the wound is essentially neutralizing that virus if it's there, so the sooner, the better.

updated: March 10, 2021
originally published: July 22, 2016