Deb Arends knows a lot about bats.
She knows that a single bat can eat a thousand mosquitoes in an hour, that they eat the mosquitoes in flight.
She knows bats have to drop to fly, which is why they hang on to the side of the house, getting ready to drop and fly.
And Arends knows exactly how it feels to wake up with a bat in your bed.
It was a Sunday morning last year in mid-August — the height of bat season — when Arends felt something by her side. She scooped it up and flung it away. It was a bat.
So she screamed.
The bat — often described as mouse-like with wings and stapler-like teeth — ended up hanging on her bedroom drapery.
Arends got the grandkids' butterfly net, captured the lethargic bat and put him in a little plastic container.
She showered. (After all she’d just met a bat in bed.) She left the captured bat on her porch and went out for breakfast.
Animal Control picked up the bat, had it tested, and late Tuesday afternoon Arends got the results. The bat had rabies.
Arends immediately contacted her doctor and set up an appointment for the next morning. Her doctor referred her to Bryan East's specialty clinic, where she started the two-week series of shots that would assure she wouldn’t die from rabies.
Arends knew not to mess with a potential bat bite.
The experts recommend people get the shots if they are in the same room with a bat, even if they do not know for sure that the bat has rabies, or if they have come in contact with a bat and the bat is not captured and tested for rabies.
Even bat saliva in a cut, or accidentally rubbed in your eye is dangerous.
Rabies is fatal. There is no cure. Without the immunization shots, you die.
The shots in Lincoln are generally not available from a doctor. It’s too rare an event for every doctor to carry the vaccine or immune globulin needed for treatment, said Celia Weskamp, drug policy coordinator at Bryan Health.
So the hospital specialty clinics are generally where Lincoln residents go for the series of shots.
Arends was sent to Bryan's specialty clinic, where she waited several hours while staff got the medicine.
The treatment consists of immune globulin, which strengthens the body's natural defenses, followed by rabies vaccine shots over the next two weeks.
“The immune globulin is human blood, just like a vampire movie,” Arends said.
The shots are no longer the ordeal they once were.
Arends was really tired and was sore at the site of the injection. But Arends, who is a cancer survivor, ranks health issues through that prism. “I’m a high-energy person and it pulled me down a bit. But it wasn’t that bad.”
Arends had previously seen bats in and around her central Lincoln home. She found a dead one in her furnace air filter once. She had a cleaning lady quit after a bat flew through the kitchen.
But one rabid bat in the bedroom requires expert help. So Arends called in the bat experts, who — for around $1,800 — sealed her attic, caulked and filled up potential entry points, installed a stainless steel chimney cap, and put in a one-way tube so bats could fly out, but not into, the house.
“I thought we were good.”
But Arends had two more big surprises awaiting her that winter.
In late fall, when she was pulling out some of her Christmas decorations — Arends is an interior designer who loves Christmas — she found a half-dead bat, then two more. She discovered that a cedar-lined attic closet had been home to many bats.
The bat control company returned, found at least five more places where bats were coming in and put in another tube.
But the bat guano remained in that attic closet. No one really wants to clean up bat poop, Arends discovered. If they do, the cost is $2,000 or more, and removal was not covered by her home health insurance which excludes contamination like urine or toxic waste.
People can get histoplasmosis, an infection that affects lungs, from breathing in spores of a fungus that can develop in bat guano.
"Google it. You don't want that," Arends said.
So Arends and a friend put on hazmat suits, bought disinfectant and cleaned up the attic closet themselves. She threw away vintage dolls and fake evergreen, wiped down every plastic box that may have come in contact with a bat. And she sealed up the cracks in the room with so much spray foam the house might float in a flood.
But she didn’t need to get rabies shots again because she still had immunization. And the second bat tested did not have rabies.
Then around Christmas time Arends got another shock — the bill from the hospital for her six shots. She'd needed two immune globulin, which are concentrated antibodies to fight an infection, and four rabies vaccine shots.
Arends had Googled the cost question. She expected a big bill, maybe $500 a shot, probably several thousand dollars total.
The bill was $11,968.29.
She was appalled.
Arends' insurance, the federal Medicare program for seniors, paid most of the bill. But Arends is concerned about other people with high deductibles or no insurance.
She’s heard of two children and a mom who needed to get the shots and had a $30,000 bill.
She knows of people who needed more of the immune globulin and had a $14,000 individual bill.
You don’t negotiate with a hospital over the cost of rabies shots ahead of time, Arends said.
“You don’t have a choice. You have to do it or you don’t survive.”
The average charge for the series of four treatments is about $11,000, said Edgar Bumanis, director of public relations and marketing at Bryan Health, who provided information on the charges.
About two-thirds of the cost for treatment is in the immune globulin, given at the first visit. It is given based on the weight of the patient and cost ranges from $4,000 to $14,000. The actual rabies vaccine, is about $1,000 for each vaccine and administration, he said.
Bryan does offer discounts and financial incentives that may reduce the patient's responsibility significantly, he said.
The state Health and Human Services Department is surveying the 500 people the state knows received a recommendation to get a rabies vaccination since 2013.
That survey will help confirm how many people received treatment along with other information like where they went for care, where they received shots, the cost of shots and if they did not receive shots, what were the barriers, said Leah Bucco-White, a communications manager with DHHS.
Arends now has a folder full of bat information. Friends get her bat presents, like the book titled “It’s Not Over 'Til the Bat Lady Sings."
She has a large bat sticker on her mirror and she hung rubber bats on her back porch for Halloween.
And one night recently, she heard some noise in her attic, as the last of the bats, she hopes, ended their winter hibernation and flew away.