healthofcitizens

Each year, more than 4.5 million dog bites occur in the United States. Despite what you might assume, most of these incidents don’t happen when an unfamiliar dog attacks someone in a park or another outdoor location. Instead, most dog bites are inflicted by a pet dog in a home.

Here’s advice for avoiding these upsetting and potentially serious injuries — and the steps you should take if you sustain a dog bite.

Why do dog bites happen?

Some dog bites happen by accident when people wrestle or play tug-of-war with their dog. But most of the time, dogs bite people as a reaction to feeling stressed, threatened, scared, or startled, according to the American Veterinary Medical Association (AVMA). More than half of dog bites occur in children, and they’re far more likely to be seriously injured than adults.

“People don’t always heed the behavioral signals that a dog is uncomfortable,” says Dr. Christopher Baugh, associate professor of emergency medicine at Harvard Medical School. For example, some dogs are highly territorial and will bark, growl, snap, and lunge if outsiders enter their space — whether that’s an apartment, yard, or crate. Or dogs may exhibit resource guarding, which shows up as anxious, aggressive behavior around food, toys, or beds.

“These situations can be high-risk, and children in particular have less awareness of that risk,” says Dr. Baugh, who has children and two mixed-breed rescue dogs, Harley and Roxi.

What can you do to prevent dog bites?

Any dog — even a sweet, cuddly dog — can bite if provoked, according to the AVMA. Never leave young children alone with a dog without adult supervision. And teach children to never disturb a dog while it’s eating, sleeping, or caring for puppies.

In a study of 321 facial dog bites treated at Harvard-affiliated Massachusetts General Hospital over a 20-year period, 88% of the bites were from known dogs. Most were in adults and occurred after playing with the dog, feeding the dog, and placing their face close to the dog. However, the hand (usually a person’s dominant hand) is probably the most common location for a dog bite in an adult, says Dr. Baugh.

Other tips from the CDC to prevent dog bites include the following:

• Always ask a dog’s owner if it’s okay to pet their dog, even if the dog appears friendly.
• Make sure the dog sees and sniffs you before reaching out to pet it.
• Don’t pet a dog that seems to be hiding, scared, sick, or angry.

What if an unfamiliar dog approaches you? Remain calm and still, avoiding eye contact with the dog. Stand with the side of your body facing the dog and say “no” or “go home” in firm, deep voice. Wait for the dog to retreat or move yourself slowly away.

What should you do if you’re bitten by a dog?

Clean the wound with mild soap and running water, then cover it with a clean bandage or cloth. Some online resources recommend applying an antibiotic ointment or cream. But these products are recommended only for people with clear evidence of an infection, such as redness, pus, pain, swelling, or warmth, according to the American Academy of Dermatology.

If the injury is serious — with a bite on the face, heavy bleeding, or a possible broken bone — go to the emergency room. That’s also a good idea if you’re bitten by an unknown or stray dog, in the rare event that you might need medicines to prevent rabies (rabies post-exposure prophylaxis).

“Often, people are shocked after being bit and will understandably focus all their attention on their wound,” says Dr. Baugh. The dog’s owner may check in to see if you’re okay, but then walk away. But you should get the person’s contact information and make sure the dog is vaccinated against rabies, he says.

Keep in mind that:

• Emergency rooms are often crowded with long waits, so an urgent care clinic is a good option if the injury doesn’t require immediate attention.
• Some wounds require stitches, ideally within 12 to 24 hours.
• The doctor may prescribe antibiotics to prevent possible infections, especially if you have health problems such as a weakened immune system or diabetes.
• You may also need a tetanus booster if you haven’t had one in the past 10 years. If your vaccine history isn’t available or you can’t remember, you’ll get a tetanus booster just in case.

What if a dog bite is less serious?

Let’s say you have a less serious bite from a family dog known to have a current rabies vaccine. Bites that don’t require stitches can be cleaned with mild soap and running water, then evaluated by your regular health care provider. They may tell you to simply monitor the wound for signs of infection.

“Doctors are trying to be more thoughtful about prescribing antibiotics and limit their use in low-risk situations, because overuse contributes to antibiotic resistance and exposes people to potential side effects without any benefit,” says Dr. Baugh.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Need a little motivation and structure to ramp up your walking routine? Want to wake up your workouts but not quite ready for a mud run? Consider trying a couch-to-5K program.

Dr. Adam Tenforde, medical director of the Spaulding National Running Center at Harvard-affiliated Spaulding Rehabilitation Network and a sports medicine physician at Mass General Brigham Sports Medicine, shares tips on what to know and do before lacing up your sneakers.

What is a couch-to-5K program?

These free or low-cost coaching plans are designed to help would-be runners train for a 5-kilometer race, which is about 3.1 miles. The programs are available online, or as apps or podcasts. They typically feature timed walking and running intervals that gradually phase out the walking over a period of about nine weeks.

Why try a couch-to-5K program?

“One purpose of a couch-to-5K program is to give you time to acclimate and start to enjoy the benefits of running and the sense of accomplishment of completing a distance safely,” says Dr. Tenforde. Running provides many cardiovascular benefits, such as lower blood pressure and a reduced cholesterol level, as well as an enhanced sense of well-being, he adds.

What’s more, adding even short bursts of running or other vigorous physical activity to a workout — a practice known as high-intensity interval training or HIIT — appears to help improve mental health, according to a study that pooled findings from 58 randomized trials of HIIT.

Are you ready to tackle a couch-to-5K?

Even though the couch-to-5K programs sound as though they’re geared for completely sedentary couch potatoes, that’s not necessarily true, Dr. Tenforde cautions. These programs often assume you can walk continuously for 30 minutes, which doesn’t apply to everyone.

For some people, an even easier, more gradual training regimen may be more appropriate. Also, keep in mind that you don’t have to run to do a 5K. Many of these races also encourage walkers to participate as well. You’ll still reap the other rewards from committing to a race, such as being more challenged and motivated — and possibly more connected to your community. Many charitable “fun runs” benefit local schools or needy families. Some are in memory of people affected by illness or tragedy. Visit Running in the USA to find 5K races near you.

What to do before you start

If you’re planning to walk or run your first 5K, get your doctor’s approval before you start training. That’s especially important if you have heart disease or are at risk for it.

Comfortable walking or running shoes are a wise investment. Shoes that are too old or too tight in the toe box can cause or aggravate a bunion, a bony bump at the outer base of the big toe. Despite suggestions that people with flat feet or high arches need specific types of shoes, studies have found that neutral shoes (designed for average feet) work well for almost everyone. Walk or jog around the store when you try them on to make sure they feel good and fit properly.

You don’t need to buy special clothes; regular sweat pants or comfortable shorts and a t-shirt will suffice. Women should consider getting a supportive sports bra, however.

Go slow and steady when training

• Always include a warm-up and cool-down — a few minutes of slow walking or jogging — with every exercise session.
• If you haven’t been exercising regularly, start by walking just five or 10 minutes a day, three days a week. Or, if you’re already a regular walker, add some short stints of jogging to each walking session.
• Gradually add minutes and days over the following four to six weeks.
• Once you’re up to 30 minutes a day, check how far you’re traveling. Keep increasing your distance every week until you reach 5 kilometers. Then slowly phase in more jogging and less walking over your route if you like.

Remember that you can always repeat a week. You’re less likely to sustain an injury if you make slow, steady progress. Pay close attention to your body and don’t push yourself too much, Dr. Tenforde advises. Former athletes who haven’t run in years may think they can pick up where they left off, but that’s not a smart move — they should also start low and go slow.

For a good couch-to-5K guide, try this beginner’s program from the United Kingdom’s National Health Service.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD