How to Assist a Pet That Is Unable to Rise and Walk
Background
After surgery, injury, or as a result of illness, a pet may be unable to stand and walk normally. These dogs and cats need help to do so, especially to urinate or defecate. Movement also provides some physical activity to stay limber. It is important, whenever possible, to help a dog or cat in this condition stand and walk as painlessly as possible, and some ways for doing this are described here. The goal is to help a pet recover or at least maintain a functional amount of physical mobility.
Getting Started
For large dogs, make or purchase a sling that is long enough to fit under the dog’s abdomen (belly) and that you can hold comfortably in both hands when the dog is standing. The length of the sling will depend on the size of the dog. A longer sling will be needed for a shorter dog. For any size dog, a sling that is too short can force you to bend over to grasp the ends securely and support the weight of the pet with the back, which is not recommended. Ideally, you should be standing upright with a straight back, sling ends in each hand and supporting the majority of the weight of the dog through the strength in your legs, knees slightly bent.
In many cases a sling can be fashioned from a towel or sheet. For dogs that are experiencing generalized weakness or difficulty using all four legs, two holes can be cut into these, one for each front leg, to provide a more balanced support for the pet when walking. For this type of support, when the person is carrying most of the weight of the pet, especially with larger dogs, two people may be required (one on either side, each holding one end of the sling).
To assist a pet who is weak in the hind end and attempting to rise using the front legs, it is helpful to provide secure, nonslip footing such as a rubberized carpeted mat. Hardwood floors and linoleum are slippery; a better, higher-traction surface (covering an area at least twice the length of the pet, square) can make all the difference in helping a pet to rise.
Troubleshooting Beforehand
Above all, it is essential to protect yourself. Especially with heavy dogs, the process of lifting or carrying can be strenuous, and it is important to prevent back injuries or other similar problems in the caretaker (i.e., you and anyone helping you). Some pets may feel pain or discomfort and may respond by biting, so a muzzle should be placed over the mouth/snout if this is a risk associated with the type of injury or disorder your pet has.
Be sure that sufficient traction is available. Placing just a towel or blanket over a smooth floor is rarely useful because the cloth just slides on the floor under a pet’s scrambling feet. A better choice is to obtain an area rug or section of carpet on which your pet can lie and then have traction to help stand up.
With male dogs in particular, it is important to place a sling in such a way that it does not impede their ability to urinate. Try to support the weight of the pet farther forward on the body by having the sling about halfway between their shoulders and hips so the penis is not trapped in the sling. It may be unavoidable to keep the sling from becoming soiled. Be sure to make two slings, or purchase one that can easily be washed and dried.
Homemade slings may bunch up at the back, just ahead of the hips. Practice keeping the sling stretched flat and spread forward underneath the abdomen and chest, as if supporting your pet’s underside with a miniature hammock. This helps spread out the support and is much more comfortable on the abdomen.
Procedure for Assisting Your Pet at Home
For larger dogs, place the sling under the dog’s abdomen (belly) when he/she is lying down. If the front legs are healthy and strong, encourage him or her to rise into a sitting position. If this is successful, you can then slip the sling under the belly and, lifting the hips, back, and hind legs from both sides, help your dog into a normal standing posture. This can be done with one person only or with two people, one on each side, especially for heavy dogs. Adjust the sling, if necessary, to spread it out under the abdomen and chest. It may be helpful to have a second person lead the dog using a collar and leash. This will make it clear to the dog what is going on and where you wish him/her to go. Avoid stairs if at all possible. If stairs cannot be avoided and a dog is too large to carry, then a second person can help a great deal by supporting part of the weight of the dog at the shoulders with a second sling between the front legs to avoid stumbling and falling.
Especially when dogs or cats have injuries to the back, it may be mandatory to avoid stairs for their protection. If there are stairs in your home that a pet will have to use, please discuss this with your veterinarian in advance to search out an alternative (e.g., staying on the ground floor or finding another place to stay during recovery).
For cats and small dogs, the process is easier because they can be picked up with less effort, and a sling becomes unnecessary. If your pet is unable to stand up on his/her own, you should do so, carrying him or her outside (dogs), to the litterbox (cats), or wherever is appropriate for urination and defecation. The best way to pick up a cat or small dog is with one hand around the front (just head of the front legs, picking up the neck and chest) and one hand around the hind end (behind the back legs) and holding the pet against your chest in a gentle “bear-hug” embrace. This should be comfortable for your pet and for you; if not, you should review your approach with a veterinary technician and determine whether a different technique is necessary (see above).
When a dog is attempting to urinate or defecate, it may be impossible for him/her to posture in the usual way. You can help by providing support with a sling (or by holding the whole body if a cat or small dog) in a fairly normal posture that allows for bodily functions to occur. For example, most dogs and cats can relieve themselves in a crouching—almost sitting—position. Helping a dog or cat into this position—through holding, bracing a large dog’s feet with your own feet alongside them if the ground outside is slippery, and so on—may allow the pet to evacuate the bowels and bladder appropriately. This should be done at least every morning and night.
Afterwards
Hygiene is essential for preventing infections, and a dog or cat that does not have good bowel or bladder control should be kept especially clean when physical mobility is reduced. The longer periods of time spent in one position make the skin and tissues more prone to irritation and infection. This may mean cleaning the skin and hair with a wet towel and then drying (sponge bath), or a full bath to fully clean any soiled areas. This may best be done at the veterinary hospital and should be discussed with your veterinarian as a way of maintaining your dog or cat’s quality of life.
Frequently Asked Questions
How often should I do this?
Dogs and cats that are not able to stand and move adequately should have help to do so at least every 12 hours and preferably more, unless doing so is painful. Other exceptions include medical conditions where this would be detrimental or situations where doing so poses a risk to you or your pet. The specific timing and extent of assistance is something you should discuss with your veterinarian.
Is there anything else I should be doing?
Depending on medical status, your pet may benefit from range-of-motion exercises, which also should be discussed with your veterinarian (see separate handout).
Other Related Information Sheets
How to Perform Range-of-Motion Exercises
How to Provide Bandage Care and Upkeep at Home
How to Assist and Not Assist During Normal Birthing
Background
The vast majority of dogs and cats that give birth to normal, healthy puppies and kittens can do so without any assistance. Rarely, one may have trouble that will require a veterinarian’s intervention. The goal is to provide help to the mother when necessary, but to avoid getting in the way, adding discomfort, or harming the newborns.
Once the puppies and kittens are born, it is important to monitor their health. The top priority is to ensure that each newborn is receiving adequate nutrition and care from the mother. If the mother pushes the young away or prevents one of them from receiving milk, then your intervention may be warranted.
Whelping refers to a female dog giving birth; queening refers to a female cat giving birth.
Getting Started
Equipment/materials for birthing and immediate aftercare:
Infant nostril cleaner
Clean string/thread
Scissors
Warm damp washcloth
Dry towels
Bottle
Milk replacer
Medical exam gloves
Source of warmth for newborns
Whelping box (dogs). This is a square, low-walled pen that the mother and pups can be in together. It looks like an empty sandbox that has a 6” (15 cm) horizontal ledge protruding into the box, halfway up the inside of all 4 walls, to provide shelter for the pups and protect them from being crushed by the mother when she lies down. Such a box can be made at home and should be about 3 × 3 feet (1 × 1 meter) in length and width, and 1 foot (30 cm) high, such that the pups are contained in the whelping crate, but the mother can walk into and out of it easily.
Birthing may easily take place without any of the items listed above, but they should be available in case of an emergency.
Troubleshooting
The most common and most serious mistake people make when their dogs or cats are giving birth is to become involved when it is not necessary. The most important thing to do is observe and monitor for real problems, as described below, and bring the dog/cat that is in labor to a veterinarian only if such signs of serious problems occur.
In general, dogs and cats prefer to be in a small, quiet, dark room or closet that allows them privacy when they are ready to give birth. Mothers may prepare a nest prior to giving birth, using available paper, clothing, or other materials; this is a normal process. There is no need to intervene at this point, and doing so could be disruptive.
It is normal for the mother to be protective of her newborns. If she becomes aggressive, caution should be used. Do not put yourself in harm's way or allow yourself to get bitten by offering assistance.
Procedure
Impending birth:
Certain clues identify that birth is imminent in pregnant dogs or cats:
Body temperature decreases by 1 or more degrees Fahrenheit (typically down to 98-100°F [36-37°C] in the dog, 100.5-102.5°F [37.8-39.3°C] in the cat) in the hours prior to giving birth.
Sharp decrease in blood progesterone level (useful for testing at veterinary hospital; if level is normal/high, birth is not occurring at that moment, nor is it expected in the next 24 hours).
The number of days since mating is *not* reliable for predicting the date of birth, as this can vary widely (58-72 days in the dog, 56-69 days in the cat).
Birthing:
The first visible sign of birthing is abdominal contractions (straining). When contractions begin, one newborn should be born every 60 minutes or less until all are born. Dogs and cats can have very large litters (as many as 12 pups/kittens) or as few as 1 or 2.
Note that 30 minutes of active straining without producing a pup or kitten should prompt an immediate visit to the veterinarian, because the birth canal may be blocked.
However, the mother may normally rest between pups/kittens for up to 3 or 4 hours, without straining, before resuming labor, especially if she is being bothered or distracted by overly protective or well-meaning humans.
A delay between pups/kittens of more than 4 hours, without contractions and in an undisturbed environment, is abnormal and justifies a visit to the veterinarian.
The third stage of labor is the passage of the placentas (afterbirths) for each pup/kitten, which occurs within 15 minutes or less of each individual birth in most cases.
The mother will usually remove the placenta (afterbirth) and cut it with her teeth. If she does not and the pup/kitten is still within a membrane-like sac when born, take a lukewarm damp washcloth and wipe off the placenta and clean the newborn’s body surface. The mother may eat the placenta, which is normal.
If the mother neglects to cut the umbilical cord, this can be done for her, but the umbilical cord must be tied (typically with thread or dental floss) about 1 inch (2 cm) from the newborn and cut away from the tie. That is, the thread remains closer to the newborn than where the umbilical cord is cut, and prevents the pup from bleeding out the umbilical cord.
Do not pull the umbilical cord off the newborn, nor tie it close to the newborn’s body surface. Either of these may cause an opening in the newborn’s body wall (umbilical hernia).
Using an infant nasal cleaner, suck out the liquid debris from the mouth and nose. It may take several attempts to remove all liquid. This is a gentle suction process, so be sure not to push air into the lungs; simply push all of the air out of the nasal cleaner before inserting into the nostrils and mouth of the newborn. Do not be afraid to stimulate the newborn’s nose and mouth this way, as this helps to increase the respiratory and heart rates.
Encourage the mother to clean and care for the newborn by placing it on the ground close to her head so she can smell and lick it.
Place the puppy/kitten next to the mother's nipples, and encourage suckling. Most newborns will begin nursing within minutes of birth.
After birth:
Ensure the mother is eating well and behaving normally. Periods of interest in the pups alternating with periods of rest are normal; if she seems poorly responsive, has difficulty breathing, or otherwise shows signs that concern you, you should call your veterinarian.
Ensure that all newborns eat vigorously and are gaining weight on a daily basis. If newborns are pushed away by the mother, or if the litter is large, owners may need to supplement feeding with a bottle and milk replacer. If newborns cry all the time, they are either hungry or may have a serious medical problem.
Ensure that newborns stay warm. Do not use a heating pad in the crate or box in which the newborns are housed, however. Puppies and kittens tend to squirm under blankets and may come in direct contact with the heat source, causing burns or fatal overheating. Instead, place the heating blanket under part of the box or crate and place several towels in the crate, providing a warm, cushiony environment that the newborns can move onto or away from as needed. If the mother is providing good care, a heat source may not be needed.
Replace blankets as needed, providing a clean environment at all times.
Feeding:
If the mother is not producing milk, or not allowing the newborns to nurse, bottle feeding may be necessary. Puppy and kitten milk replacers, along with bottles, are available at pet stores. (See additional information sheet: How to Syringe-Feed, Bottle-Feed, or Tube-Feed a Pet.) Even with normal nursing, large litters (8 or more puppies/kittens) may be too much for the mother to nurse adequately, and supplementation with puppy or kitten formula may be beneficial. This warrants a call to your veterinarian.
Puppies and kittens should nurse (or be fed if the mother is not nursing) every 2 hours during the first 2 weeks of life, then every 4 hours during the third and fourth week. Solid puppy/kitten food can be introduced at 4 weeks, with bottle feeding still being the main source of food.
Once puppies or kittens are finished eating, the genitalia must be stimulated, allowing the newborn to urinate and have a bowel movement. Take a warm damp washcloth and gently stroke the pup or kitten’s groin area between the back legs until the newborn passes urine and a bowel movement (usually takes about 10-60 seconds). This is done every time the puppy or kitten eats, and elimination should occur most, but not necessarily every, time.
Do not force the newborns to suckle. Forcing fluid into the mouth may cause fluid to enter the lungs and has been fatal. If a newborn does not want to suckle, call your veterinarian for advice; a medical issue may be present.
Afterward
It is always best for the newborns to drink their mother's milk, as this provides the best nutrition and protection. However, it is imperative that the puppies/kittens get adequate nutrition. One good practice for keeping track of nutritional balance is to weigh newborns on a daily basis, ensuring weight gain.
Limited handling of the newborns is best for the first 2 weeks. Most mothers are very protective and keep a close eye on their babies.
Frequently Asked Questions
My dog had 10 puppies. Should I supplement the puppies?
Yes. Eight or more puppies is a large litter, and some puppies may not receive adequate nutrition. Make sure to supplement all puppies so that they equally receive their mother's milk.
The father of the litter tries to get into the mother's crate. Should I separate them?
Yes, separate the mother from all other pets. Occasionally, the mother is very protective of her young and may initiate a fight while trying to protect her babies. Also, other pets may try to get into the crate and might sit on the newborns, which can crush them to death.
Should I increase the mother's food?
Yes. Feeding puppy or kitten food to the mother provides extra nutrients and calories that she is passing on to the babies. It is very important that the mother receive extra nutrition while nursing (i.e., from the moment of birth until weaning, 4-6 weeks after birth).
The mother has discharge from the vulva. Should I be concerned?
In some cases yes, and in some cases no. You should call your veterinarian if you have any questions. Some discharge can be normal, but it depends on the odor and time of discharge. Your veterinarian can determine if an infection or other abnormality is present. A very foul smell, or a mother that is feeling ill, suggests infection.
When do puppies and kittens open their eyes?
Puppies and kittens begin to open their eyes as early as 7 days. Do not try to open the eyes sooner than this.
How to Bandage a Lacerated Footpad or Torn Dewclaw
Background
Laceration simply refers to a cut, which can be a simple and superficial one or a deep gash.
The dewclaw is the claw on the inner surface of the paw, like the thumb in a person. Most dogs and cats have them on the front paws, and most dogs (but not cats) have them on the hind paws as well.
Pets may accidentally cut themselves on the paw when they are outside walking, playing, or hiking, resulting in a laceration or torn dewclaw. Although these injuries can appear serious because they are often quite bloody, they are easy to manage. Applying a bandage is easy to do and can be accomplished at home.
The goal is to stop the bleeding by applying gentle, constant pressure to the area. However, it is also important to ensure that the bandage is not too tight.
Getting Started
Equipment/materials needed (mostly available at many pharmacies and in first-aid kits):
Bandage tape
Telfa pad or similar nonstick gauze material (optional)
Clean, dry, new cotton bandage material. An ideal material is Kling-type stretchable roll gauze
Vetrap, Elastikon/Elastoplast, or Ace-type roll of bandage material
A sock, such as a plain terrycloth white sweat sock, can make a useful external covering.
Troubleshooting
If the bleeding is heavy, it is most important to place a bandage on the foot to control the bleeding. You can then transport your pet to the veterinarian for evaluation. If the bleeding is light, you may clean the wound with an antibacterial soap or a diluted disinfectant solution (Betadine or chlorhexidine are commonly available at pharmacies; dilute 1 part disinfectant to at least 10 parts water before using). Rinse well with lukewarm water, dab the area dry, and apply the bandage. Tape will not stick to a moist haircoat; be sure to dry the area well.
If your pet resists, discontinue the procedure. Place a sock on the foot if needed and proceed to your veterinary hospital. Do not put yourself in harm’s way or allow yourself to be bitten.
Procedure
Apply a long strip of bandage tape directly to the skin/haircoat of the affected paw, but not on the wound. This strip should begin at least 6 inches (15 cm) up the paw and extend past the tips of the toes for at least 9 inches (22 cm). This will act to anchor the bandage to the hair and skin.
Apply a Telfa pad, if available, over the laceration or torn dewclaw. This allows for easy bandage removal.
Apply a layer of cotton bandage material. Start at the tip of the toes and work your way past the laceration in a spiral (barber pole) pattern. Each loop around the leg should cover 50% of the previous loop of bandage so there is good overlap and no gaps.
Apply a layer of Vetrap, Elastikon/Elastoplast, or an Ace bandage in similar fashion. Again, start at the tip of the toes and work your way up the leg past the laceration.
Very important: make sure the bandage is not too tight. If you are applying Vetrap or Elastikon/Elastoplast, prestretch the material by unrolling the whole roll first, then rerolling it before applying. Otherwise, the tension of unrolling the bandage while applying it will create too much tension and cause a squeezing effect on the leg that can deprive it of circulation. As a test: you should be able to insert a small finger under your bandage at the tip of the toes. If not, it is too tight.
The length of tape you applied in the first step will continue to stick out past the toes and is not covered by the bandage.
If the laceration affects one of the toes, the bandage should cover it but leave at least one or two other toes on the same foot clear of the bandage. These will be useful for checking that the bandage is not too tight.
Reflect/turn back the long piece of tape protruding from the toes, and apply it up the leg onto the bandage. This will help prevent the bandage from slipping off the leg.
Apply additional tape as needed to strengthen the bandage if necessary.
Afterwards
Always assess your pet's foot for any swelling. The toes should remain exposed past the bandage (exception: toe[s] that is/are lacerated) and will be the first to swell if a bandage is too tight. If the toes swell, remove the bandage and start over. Ensure that all layers are loose enough to prevent this type of swelling (which indicates poor circulation) but not so loose that the bandage slips off.
Your veterinarian may request that you continue to apply bandages to the area for a few days. Make sure the area is always clean and dry prior to bandage application.
If your pet will be going outside, cover the bandage with a plastic bag to prevent any moisture from getting onto the bandage. If the bandage becomes wet, you should change it. Wet bandages promote infection and gangrene.
An Elizabethan collar (E-collar) may be required to prevent your pet from removing the bandage. Do not allow your pet to chew, damage, or eat the bandage. The E-collar must be long enough that the pet cannot extend his/her foot past it to chew on the foot. Make sure, however, your pet can obtain food and water with the E-collar on (such as offering food or water by elevating the bowls by hand). It is a common myth that a dog or cat’s tongue is “antiseptic,” when in fact the antibodies that do exist on their tongues are no match for the bacteria also carried in the mouth when licking a healing tissue site.
Frequently Asked Questions
Why does the area have to be dry before the bandage is applied?
The area should be dry before applying the bandage because moisture can become trapped in the bandage, which can house and incubate bacteria. Ask your veterinarian how long you will need to continue applying and changing bandages and if you should allow the area to air dry for a few hours prior to reapplying the bandage.
What if the swelling is due to the injury, not the bandage?
Injuries can cause swelling and may need to be examined by the veterinarian. If you have any concern, call your veterinary hospital.
Should I apply an antibiotic cream to the area?
Not all lacerations need to have an antibiotic ointment or cream applied. Ask your veterinarian before you apply anything, as this may delay healing.
Should I wear gloves when cleaning the area?
Yes, you should always wear gloves when working with any wound. This will prevent you from becoming contaminated with bacteria and will prevent you from contaminating the wound.
Other Related Information Sheets
How to Assemble and Use an Elizabethan Collar
How to Bathe a Dog or Cat Using Medicated Shampoo
Background
Pets are often diagnosed with skin diseases or infections that are helped or cured with medicated bathing. Both oral medications and topical therapy (treatments applied to the skin) must be used as directed and often yield better results when used together.
Bathing and shampooing your pet is easy to accomplish and can be done at home.
Getting Started
Equipment/materials needed:
Bathtub, ideally with a spray nozzle or hose-attachment shower head. In warm weather, bathing can be done outdoors in an area with good drainage.
Plastic or metal container (bowl or small bucket) for collecting and pouring water if spray nozzle or hose attachment is unavailable.
Tube of lubricant eye ointment
Watch/clock
Medicated shampoo
Towels
A rack or grate (for cats)
For larger dogs and pets that resent being bathed, two people should be present for helping to lift or restrain the pet.
Troubleshooting
The affected skin should begin healing within the first few weeks of medicated bathing. In serious conditions, healing may take longer. However, if you notice any of the following symptoms at any time, you should contact your veterinarian immediately for a recheck:
Increased discharge from the skin
Increased redness, swelling, or heat in the area of concern
Increased pain
Spreading of the condition
Inability to give pet a bath (for example, if your pet is uncooperative, appears to be in pain from the bathing, or because you feel you are unable to perform it correctly)
Be sure to ask your veterinarian about other conditions (heart disease, respiratory disease, diseases of the eyes) if your pet has these; they could be worsened by the act of bathing if not well tolerated and might make bathing unwise.
If your pet shows resentment to having this done, stop the medicated bathing and call your veterinarian for further advice. It is imperative that you not put yourself at risk. Your pet's reaction may also be an indication that another disorder of the skin is present and that a prompt recheck is necessary.
Procedure
Place a small (1/4 to 1/2 inch [0.5 to 1 cm]) strip of sterile eye lubricant ointment on the surface of each of the pet’s eyes. This is to prevent irritation of the eyes from shampoo, because pets do not know to keep their eyes closed during shampooing.
Place your pet in the bathtub, and prepare to soak the pet’s haircoat from head to toe with lukewarm water. Be sure the water is lukewarm and comfortable to the touch, especially if the pet’s skin is inflamed or reddened (too hot or too cold can be very painful).
Begin soaking with water at the top of the head and down the spine for the length of the whole body, so gravity pulls the water downward and soaks through to the skin. Use one hand to direct the jet (or pour from a small bucket or bowl) and the other hand to direct the water deep into the haircoat when bathing thick-coated animals. This soaking can take less than a minute in thin-coated dogs and shorthaired cats, longer (up to 10 to 15 minutes) in heavy-coated dogs with dead skin, dried secretions, or other debris that soaking can help to soften and loosen.
Lather the shampoo into your pet's coat. For many medicated shampoos, it is important to allow the shampoo to sit for 10 minutes, or the prescribed time if otherwise indicated by your veterinarian or by the product instructions. This contact time allows the medicated part of the shampoo to work; use a watch or clock to keep track of the time.
Rinse well. Ensure all soap is removed. A thorough rinsing should take at least as long as the shampooing—10 minutes or more in many cases.
Towel dry (do not blow dry coat).
For cats, a grate or rack may be placed in the bottom of the tub; this allows your cat to grab onto something while being bathed, as many cats resent baths.
Afterwards
The skin may appear redder immediately after a bath because of increased circulation. You should compare the color, temperature, and comfort level/lack of pain of the skin at the same time day after day to see whether the skin disorder is improving or worsening.
Frequently Asked Questions
Why shouldn’t I blow dry my pet's hair coat after a medicated bath?
It is advised to let the coat air dry. Although you have rinsed the pet's hair coat well, some residue remains that stays in contact with the skin. Appling heat may deactivate the medication that is to remain in contact with your pet's skin.
Can I use medicated shampoo that is made for humans on my dog or cat?
Usually not, because most medicated shampoos made for dogs and cats contain ingredients designed to work well with animal skin specifically. Human skin is very different from dog or cat skin, and shampoos made for people may cause irritation, drying, and inflammation of the skin of dogs or cats.
My veterinarian advised me to bathe my pet twice weekly. However, I have read in my dog magazine that I should not bathe him more than once a month. Should I continue with the doctor's recommendation?
Medicated shampoo has been developed to be used more frequently than regular pet shampoo. Also, the medicated baths will only occur for a short time. Once your pet's skin condition has resolved, you may continue to bathe him or her with regular shampoo monthly.
Can I buy medicated shampoo at the pet store?
No. Some medical-sounding claims are made by products available at pet stores, and indeed, just lukewarm water (hydrotherapy) is beneficial to the skin. But the medicated shampoos required for treating skin diseases are prescription products and must be dispensed by your veterinarian.
Can the groomer apply this shampoo?
If you cannot bathe your pet, you may call a groomer and ask if he or she will bathe your pet with your medicated shampoo, as directed. Advise the groomer of the condition for which your pet is being treated.
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How to Care for a Dog After Heartworm Adulticide Treatment
Background
Heartworm disease is a serious but treatable health problem. It is caused byDirofilaria immitis, a worm that resides in the circulation (heart and lungs) of dogs and cats and is transmitted by mosquitoes.
Heartworm adulticide medication, a product called melarsomine (Immiticide), is a set of injections that kill the heartworms in a dog. It is extremely important that they do so gradually. Too sudden a worm kill can cause the dead worms to obstruct blood flow and could be life threatening. Home care after a dog has received heartworm adulticide injections is the single most important thing you can do to prevent harm related to heartworm disease during treatment.
The goal of home care after heartworm adulticide injections is to preserve a state of minimal to no symptoms for the entire posttreatment period while the worms die slowly and are gradually destroyed by the body. This requires strict exercise restriction, which is the cornerstone of postinjection care at home. Allowing a dog to run and play during this period is extremely dangerous (life threatening) and must be avoided. See below.
Getting Started
With minor variations, treatment of heartworm disease typically takes 2-5 months to complete. The most important thing you can do during the treatment is to restrict your dog’s physical activity to a bare minimum of short leash walks for bodily functions (urinating, defecating) only.
Exercise restriction must begin immediately on the day of the first heartworm adulticide injection. In most cases, injections are given as 2 sets: 1 injection initially, then 4 weeks later, 2 more injections given 24 hours apart. Therefore, for most dogs, the restriction of activity lasts a total of 8 consecutive weeks. For playful, energetic dogs, this can be difficult, but the alternative (a risk of fatal heart problems if exercise is not restricted, or if no treatment is given) is worse.
Your dog will also need to receive an antibiotic, doxycycline, which weakens the heartworms and makes the heartworm adulticide injections most effective. You should give this antibiotic to your dog until the veterinarian directs you to stop, typically once or twice a day for a period of 1-2 months leading up to (and overlapping with) the adulticide injection treatment. Some dogs develop indigestion from this antibiotic, so be sure to contact your veterinarian to discuss an alternative if you observe loss of appetite or vomiting.
Troubleshooting Beforehand
There is no reason to allow running, jumping, or other physical activity at any time for 8 weeks after the start of the injectable heartworm adulticide treatment. All physical exertion must be stopped beginning the day of the first injection, 24 hours a day, for the full 8-week period, to reduce the risk of serious (life-threatening) heartworm-related problems.
Procedure: How to Care for Your Dog During Treatment
After receiving the first injection, your dog must remain as quiet and inactive as possible for the next 8 weeks (confine to crate or small room). This may seem unfair, but the alternatives, namely untreated heartworm disease or treatment without restricting exercise, are worse and potentially life threatening.
Short, slow leash walks (5-10 minutes) are appropriate for urinating and defecating, 2-3 times a day at most.
Dogs who are allowed to run or play during this time can develop life-threatening problems such as a stroke. Treatment makes the heartworms fragile, so the body can break them down slowly over the next 8 weeks. Allowing vigorous activity at any time in these 8 weeks can cause the weakened heartworms to shatter, causing a clot of worm fragments that blocks off blood flow to the lungs, brain, or other organs (“shaking the tree” phenomenon). This causes a stroke or sudden death. Conversely, exercise restriction means the worms are slowly broken down by the body until gone, with no symptoms or problems.
Respiratory symptoms are important if you see them: if your dog is acting abnormally, develops a new cough, or has difficulty breathing, you should call your veterinarian promptly. These symptoms may be unremarkable, but often they are the first sign of a mild reaction to dying worms, requiring an immediate recheck visit.
Depending on each case, some dogs may receive oral cortisone tablets (prednisone), which you should give as directed. Other dogs may not need this treatment or only receive it on an as-needed basis if respiratory symptoms such as coughing occur.
You will be asked to return in 4 weeks for the next treatment series.
The second and third injections are given 24 hours apart, 1 month after the first injection. This means your dog will usually need to spend the night in the hospital for observation. This is the final treatment in the series.
When discharged after the third injection, your dog must remain as quiet/inactive as possible for the next 4 weeks, as noted above. After 4 weeks, limited activity may be slowly increased.
Respiratory symptoms are important, as described above.
Continue giving heartworm preventative on a monthly basis.
Afterwards
It is expected that with this approach, there will be no complications and you should see your dog acting, eating, breathing, and behaving normally during the treatment period. Should your dog exhibit any of the symptoms mentioned, call your veterinarian immediately.
If you will be unable to keep your dog confined during the entire treatment, you may discuss any alternatives that your veterinarian may have available. The risk of sudden death on exercise is so high that every option must be investigated.
Your veterinarian should re-test your dog for heartworm disease in 6 months. Your dog can slowly resume activity during this time. Remember to give all of your dogs a heartworm preventative monthly.
Alternatives and Their Relative Merits
Giving monthly heartworm-prevention drugs may gradually kill adult heartworms. However, they do so very slowly (1-2 years), and the race between slow worm death and the damage they are inflicting before they die continues. The purpose of injectable heartworm adulticides is a more rapid and complete elimination of the heartworms.
Frequently Asked Questions
Why do I have to give an antibiotic? Aren’t the injections enough?
Doxycycline, the antibiotic of choice, has greater effect than any other antibiotic in the treatment of heartworm disease. It kills an organism,Wolbachia, that lives inside heartworms and on which the heartworms depend. Thus, doxycycline weakens the heartworms and makes them more vulnerable to the adulticide injections. It is imperative to give the antibiotic treatment the entire time recommended by your veterinarian, barring symptoms of intestinal upset (loss of appetite, vomiting, which warrant a call to your veterinarian).
Why is exercise restriction so important?
When the worms are dying off, the worm bodies circulate in the blood stream. Increased activity increases the blood pressure and circulation, which can cause an embolism, or blood clot, in the vessel. This can cause a stroke or sudden death.
How did my dog get heartworm disease?
Heartworms are carried by mosquitoes. An infected mosquito bit your dog, depositing the worm in the tissues.
Do the heartworm adulticide injections hurt?
No, the injections are painless. About 20% of dogs develop inflammation over the injection site 2-5 days after injection, which creates soreness. If this appears to be the case, please contact your veterinarian.
Can I get heartworm disease?
There have been reports of humans developing heartworm disease, possibly as a result of immunocompromised in the human. These reports are extremely rare, and having a dog with heartworm disease does not pose a significant risk to immunocompromised or immunocompetent people under normal conditions. The risk for all mosquito-borne diseases should be reduced through basic mosquito-control measures (water buckets should be emptied, areas of standing, uncirculated water should be drained, etc.).
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How to Care for a Dog in a Cart/Wheelie
Background
Occasionally, elderly dogs may become disabled, or younger dogs may suffer a debilitating injury, leaving them unable to use the hindlimbs (back legs). These pets are often still alert and normal in their behavior, and with proper care and a little extra help, they can continue to enjoy happy, healthy lives. Caring for pets that have paralyzed hindlimbs can be very rewarding for a pet’s family when the pet is considered a member of the family, and the family has the time, financial resources, and housing arrangements that allow for the extra day-to-day measures needed by a dog that cannot use some of his or her legs.
Dogs may need to use a cart or wheelie to remain mobile for a variety of reasons. Some dogs may have acquired a serious disease such as hip dysplasia, degenerative myelopathy (DM), intervertebral disk disease, bone cancer, or arthritis. Dogs may have had a limb amputated as the result of injury or disease. Depending on the severity of disease, carts can extend the dog’s life by a number of years. Front, rear, and four-wheel carts are available for dogs, and this document will focus on the most common type, which is a two-wheeled cart for a dog that cannot use the hindlimbs. Regardless of type, a cart should always be fitted for each patient.
Getting Started
Equipment needed:
Proper-fitting cart
Pet booties
Baby wipes
Troubleshooting
Pets in carts generally require extra care. You should check daily for any pressure sores that can develop at the contact points between your dog and the cart, and you will also need to allow the dog time out of the cart. Time out of the cart helps prevent pressure sores from forming. Pets should only be in the carts under supervised conditions.
Some dogs that cannot use the hindlimbs because of spinal injuries may not be able to control the passage of stool (defecation) or urine (urinary retention or the other extreme, urinary incontinence). If this is the case, the amount of work involved is significantly higher, and you should discuss with your veterinarian whether a cart is adequate. Many dogs with inability to use the legs together with urinary or fecal elimination problems are not felt by their families to have a good quality of life, and you should discuss this with your veterinarian to determine whether the work that will likely be required from you is prohibitively time consuming or difficult.
Pets may need to be trained to use the cart. Some dogs will adjust quickly to the carts, whereas others may require more time.
The dog’s living quarters should be analyzed, looking for any hazards the cart may become caught on, or that the cart may damage. Couches, chairs, or ornamental furniture may have to be adjusted to accommodate the pet and passage of the cart. Pools or ponds should be gated, preventing the dog from getting close to an unsupervised body of water at any time.
You should remain aware of inclement weather conditions to prevent your dog from injuring him/herself in snow, rain, or mud.
Procedure
Several companies have carts available to order. You should be cautious and look for a company that requires photos and measurements. One cart does not fit all, and each dog should be evaluated for the best-fitting cart. This will help prevent injury and sores in the future.
Once the cart has been received, allow your dog to become comfortable with the cart in the home. Allow your dog to smell the cart and know that it is part of the household for at least a day or two before attempting to place him or her in the cart.
The cart company should provide detailed instructions on the use of their cart. Read the instructions fully, and make adjustments to the cart as needed. Typically, these include adjusting the cart length, length of belt, and other fittings as needed.
Once you have placed your dog in the cart, provide positive feedback. Offer treats as a training method, allowing your dog to slowly walk with the new device. Many dogs do not understand what the purpose of the cart is at first, and it may be helpful to have one person 10-20 feet (3-6 meters) ahead to offer treats while another person walks alongside, even with a leash connected to the dog’s collar as during a normal walk.
As a dog becomes more comfortable with the cart, he or she will usually increase speed and maneuvering with the cart. Ensure that furniture in the home has been moved, preventing the dog from getting “caught” on the corners. One particularly common snag is doorways, and you may have to help your dog adjust to them, as taking corners too sharply can catch the cart in the door frame. It is a simple matter to lift the cart and hind end of the dog in one move and reset it so the dog can then clear the door. Many dogs learn to adapt and take turns wider over time, but some never do.
Traction is very important, because some dogs may have a hard time walking on smooth surfaces like wood or tile floors. This is especially true if two legs are completely paralyzed (requiring the cart) but the other two legs are also weakened or affected. Be sure to provide a surface that is flat but provides traction, especially when starting out. Pavement, a lawn where the soil is tamped and very smooth, and wall-to-wall carpet are good options; a throw-rug can also be good if it is long enough to allow several steps to be taken without the rug bunching up. Another option is simply to place pet boots on the paws of the legs the dog can use, to provide traction regardless of the texture of the floor; these should be removed when the pet is at rest so the feet can “breathe” and to avoid moisture accumulation.
Ramps can be very helpful for clearing stairs into and out of a house.
Allow your dog 5 to10 minutes in the cart several times daily for the first couple of days. Gradually increase the time over the next month. Remember that new muscle groups will be used as your dog adjusts to the cart. A dog using a cart for the first time may become sore and tired during the initial training period, but the increased mobility seems to outweigh this, and most dogs can learn to thrive with their carts.
Afterwards
Some pets may also benefit from acupuncture, physical rehabilitation, and/or massage, especially if the injury was a sudden one and recovery is ongoing. Consult with your veterinarian to see if this is an option for your dog.
If pressure sores should develop, clean the area with a diluted, mild (veterinary-made, since human products can be profoundly irritating to dog skin) antibacterial soap and gauze. Call your veterinarian to determine if further treatment should be provided. Examine the cart and determine what has caused the pressure sore, and provide extra padding in the area to prevent further injury. Padding may have to be changed and/or cleaned frequently to prevent pressure sores from developing.
Frequently Asked Questions
Can a cart make a dramatic difference in the life of my dog?
Absolutely. Dogs rely on a variety of smells and sounds to remain in touch with the world around them, and a cart allows them to do this. That said, dogs can be similar to people in terms of variety of personality, and some very outgoing dogs will be delighted to make the greatest use of a cart, whereas some quieter, easygoing dogs can be less enthused.
I am concerned that my pet will be immobile during the day when I am at work. Is it worth only having a few hours of time in the cart each night?
Many pet owners are concerned about their pet’s activity during the day. However, research has confirmed what many of us suspected all along, which is that most pets sleep during the day when their owners are away. Therefore, a dog that cannot use his or her legs can still enjoy the interaction in the evening and on weekends when family members are home.
Will my pet be able to play with other pets while in the cart?
Yes, absolutely. The other dogs may be puzzled at first, but most get used to it. Most dogs play with the upper body and nose, and a cart allows this to happen.
Can I bathe my pet?
Yes. Simply remove the cart and bathe as normal. If your dog has urinary or fecal incontinence, you may need to bathe him or her more frequently than a mobile pet, for reasons of basic hygiene and to keep sores from forming if the haircoat has been soiled.
Can my dog urinate and defecate while in the cart?
Yes, depending on the severity of the disease, most will try to urinate and defecate; some spinal cord lesions may affect the bladder and/or the anus, and in such cases elimination may be more difficult or less difficult (incontinence). In many cases, using the cart may make it easier for a dog to relieve himself/herself than without!
How long should I leave my dog in the cart at one time?
This can depend on the dog. At first, 5 to 15 minutes is reasonable just for becoming accustomed to it. Once a dog has adjusted to it and understands how it moves, he or she can stay in it for longer periods of time. Some dogs may be able to rest in the cart, whereas others will need to be removed. A time limit of 2 hours is reasonable for a dog to be in the cart, and this can be adjusted based on the dog’s tolerance and display of enjoyment or fatigue.
How to Change a Bandage and Assess for Infection
Background
Bandages may be applied to your pet for a variety of reasons—lacerations (cuts or gashes in the skin), fractures (broken bones), or protection of a surgical site during healing, for example. Whatever the case, bandages must be changed regularly (often every day) to reduce the risk of serious infection and delayed healing or tissue breakdown.
Getting Started
Equipment/materials needed (most available at your veterinarian or a pharmacy):
Antibacterial soap, such as diluted povidone iodine (Betadine) or chlorhexidine solution or other cleaning solution prescribed by your veterinarian. It is usually necessary for you to dilute the disinfectant to 1 part disinfectant to 10 parts tap water (1:10) before using it.
Nonsterile medical gloves (such as latex exam gloves)
Clean terrycloth, tube-type sweat sock
White cloth-type medical bandage tape
Telfa Pad (nonstick gauze material)
Cotton bandage material: 1 or 2 rolls
Vetrap or Ace-type elastic bandage: 1 or 2 rolls
Troubleshooting
If your pet shows pain or resentment to bandage changes, stop the procedure and call your veterinarian for further advice. The area may be too painful to treat without additional medications, and it is imperative that you not cause pain to your pet or put yourself at risk. This may also be an indication that the infection is worsening and should be assessed immediately.
One of the main precautions when placing a bandage is to be sure it is not too tight. Skin should be visible on either end of the bandage and must be monitored for warmth, color, and lack of swelling. Cool skin; pale, blue, or deep red skin; or swollen skin can indicate an excessively tight bandage that is compromising circulation and must be changed immediately.
An unpleasant odor emanating from a bandage, splint, or cast may indicate infection. The bandage should be checked by a veterinarian within 24 hours.
If your pet does not stop trying to lick or chew the bandaged area, it may be because they are experiencing pain, the area is infected, or the bandage has been placed improperly.
Procedure
Remove old bandage carefully. If you are using scissors, remove one layer at a time to prevent accidentally cutting your pet's skin.
Check the temperature of the skin; the entire area around the bandage should be a normal temperature like the adjacent and opposite side, not cold. For example, if the right front leg is bandaged, compare the temperature of that leg to the left front leg. They should be the same.
Observe the area of concern for any fluid discharge. A small amount of clear, slightly gummy, tan fluid (like fluid “weeping” from a skinned knee in a child) is normal, but it should be odorless. Infection may produce greenish fluid discharge, creamy yellow pus, and/or a foul smell (like spoiled food).
Look for any discolored (blackish, hardened, or dried tissue), mushy, or otherwise grossly abnormal tissue, which may indicate early stages of gangrene.
If indicated by your veterinarian, clean the area with antibacterial soap. This requires using a diluted (1:10, with tap water) solution of disinfectant soap/solution prescribed by your veterinarian, ensuring that it is at your body temperature immediately before using, because cool or warm solutions can be excruciatingly painful on fresh, healing tissues. The solution is poured or gently squirted onto the area needing disinfection and rinsing, and the liquid that flows off the area is caught onto a towel.
Remove any dead tissue, loose debris, or discharge from the area by lightly dabbing at the area with sterile dry gauze.
Allow the area to dry, especially surrounding hair. You may use a hairdryer (on the cool setting) to aid in the drying process of the hair, but do not aim the hair dryer at the open wound.
Apply a long strip of bandage tape directly to the skin/haircoat of the affected paw, but not on the wound. This strip should begin at least 6 inches (15 cm) up the paw and extend past the tips of the toes for at least 9 inches (22 cm). This will act to anchor the bandage to the hair and skin.
Apply a Telfa pad, if available, over the laceration or torn dewclaw. This allows for easy bandage removal.
Apply a layer of cotton bandage material. Start at the tip of the toes and work your way past the laceration in a spiral (barber pole) pattern. Each loop around the leg should cover 50% of the previous loop of bandage so there is good overlap and no gaps.
Apply a layer of Vetrap, Elastikon/Elastoplast, or an Ace bandage in similar fashion. Again, start at the tip of the toes and work your way up the leg past the laceration.
Very important: make sure the bandage is not too tight. If you are applying Vetrap or Elastikon/Elastoplast, prestretch the material by unrolling the whole roll first and then reroll it before applying. Otherwise, the tension of unrolling the bandage while applying it will create too much tension and cause a squeezing effect on the leg that can deprive it of circulation. As a test: you should be able to insert a small finger under your bandage at the tip of the toes. If not, it is too tight.
The length of tape you applied in the first step will continue to stick out past the toes and is not covered by the bandage.
If the laceration affects one of the toes, the bandage should cover it but leave at least 1 or 2 other toes on the same foot clear of the bandage. These will be useful for checking that the bandage is not too tight.
Reflect/turn back the long piece of tape protruding from the toes and apply it up the leg, onto the bandage. This will help prevent the bandage from slipping off the leg.
Apply additional tape as needed to strengthen the bandage if necessary.
Afterwards
Always assess your pet's foot for any swelling. The toes should remain exposed past the bandage (exception: toe[s] that is/are lacerated) and will be the first to swell if a bandage is too tight. If the toes swell, remove the bandage and start over. Ensure that all layers are loose enough to prevent this type of swelling (which indicates poor circulation) but not so loose that the bandage slips off.
Your veterinarian may request that you continue to apply bandages to the area for a few days. Make sure the area is always clean and dry prior to bandage application.
If your pet will be going outside, cover the bandage with a plastic bag to prevent any moisture from getting onto the bandage. If the bandage becomes wet, you should change it. Wet bandages promote infection and gangrene.
An Elizabethan collar (E-collar) may be required to prevent your pet from removing the bandage. Do not allow your pet to chew, damage, or eat the bandage. The E-collar must be long enough that the pet cannot extend his/her foot past it to chew on the foot. Make sure, however, your pet can obtain food and water with the E-collar on (such as offering food or water by elevating the bowls by hand). It is a common myth that a dog or cat’s tongue is “antiseptic,” when in fact the antibodies that do exist on their tongues are no match for the bacteria also carried in the mouth when licking a healing tissue site.
Frequently Asked Questions
Why does the area have to be dry before the bandage is applied?
The area should be dry before applying the bandage because moisture can become trapped in the bandage, which can house and incubate bacteria. Ask your veterinarian how long you will need to continue applying and changing bandages and if you should allow the affected area to air dry for a few hours prior to reapplying the bandage.
What if the swelling is due to the injury, not the bandage?
Injuries can cause swelling and may need to be examined by the veterinarian. If you have any concern, call your veterinary hospital.
Should I apply an antibiotic cream to the area?
Not all lacerations need to have an antibiotic ointment or cream applied. Ask your veterinarian before you apply anything, as this may delay healing.
Should I wear gloves when cleaning the area?
Yes, you should always wear gloves when working with any wound. This will prevent you from becoming contaminated with bacteria and will prevent you from contaminating the wound.
How often do bandages have to be replaced?
Specific instructions and schedules for bandage changes should be addressed by a veterinarian, because the frequency of bandage change is completely dependent upon the type and extent of the injury. Wounds that are deep or contaminated may require draining to heal. These types of bandages are changed more frequently, such as daily or even twice daily at first. Commonly, by the time your pet is discharged from the hospital, it is safe to change these bandages once daily until drainage decreases and then less frequently as healing advances. Superficial wounds that are not draining may be safely bandaged for longer than 1 day. Bandages that are placed for support (serving a splint-like function when there is no penetrating injury or break in the skin) are often changed on a weekly basis. In all cases, bandages that are wet, soiled, or have a foul odor should be changed immediately.
How to Care for a Dog After Heartworm Adulticide Treatment
Background
Heartworm disease is a serious but treatable health problem. It is caused byDirofilaria immitis, a worm that resides in the circulation (heart and lungs) of dogs and cats and is transmitted by mosquitoes.
Heartworm adulticide medication, a product called melarsomine (Immiticide), is a set of injections that kill the heartworms in a dog. It is extremely important that they do so gradually. Too sudden a worm kill can cause the dead worms to obstruct blood flow and could be life threatening. Home care after a dog has received heartworm adulticide injections is the single most important thing you can do to prevent harm related to heartworm disease during treatment.
The goal of home care after heartworm adulticide injections is to preserve a state of minimal to no symptoms for the entire posttreatment period while the worms die slowly and are gradually destroyed by the body. This requires strict exercise restriction, which is the cornerstone of postinjection care at home. Allowing a dog to run and play during this period is extremely dangerous (life threatening) and must be avoided. See below.
Getting Started
With minor variations, treatment of heartworm disease typically takes 2-5 months to complete. The most important thing you can do during the treatment is to restrict your dog’s physical activity to a bare minimum of short leash walks for bodily functions (urinating, defecating) only.
Exercise restriction must begin immediately on the day of the first heartworm adulticide injection. In most cases, injections are given as 2 sets: 1 injection initially, then 4 weeks later, 2 more injections given 24 hours apart. Therefore, for most dogs, the restriction of activity lasts a total of 8 consecutive weeks. For playful, energetic dogs, this can be difficult, but the alternative (a risk of fatal heart problems if exercise is not restricted, or if no treatment is given) is worse.
Your dog will also need to receive an antibiotic, doxycycline, which weakens the heartworms and makes the heartworm adulticide injections most effective. You should give this antibiotic to your dog until the veterinarian directs you to stop, typically once or twice a day for a period of 1-2 months leading up to (and overlapping with) the adulticide injection treatment. Some dogs develop indigestion from this antibiotic, so be sure to contact your veterinarian to discuss an alternative if you observe loss of appetite or vomiting.
Troubleshooting Beforehand
There is no reason to allow running, jumping, or other physical activity at any time for 8 weeks after the start of the injectable heartworm adulticide treatment. All physical exertion must be stopped beginning the day of the first injection, 24 hours a day, for the full 8-week period, to reduce the risk of serious (life-threatening) heartworm-related problems.
Procedure: How to Care for Your Dog During Treatment
After receiving the first injection, your dog must remain as quiet and inactive as possible for the next 8 weeks (confine to crate or small room). This may seem unfair, but the alternatives, namely untreated heartworm disease or treatment without restricting exercise, are worse and potentially life threatening.
Short, slow leash walks (5-10 minutes) are appropriate for urinating and defecating, 2-3 times a day at most.
Dogs who are allowed to run or play during this time can develop life-threatening problems such as a stroke. Treatment makes the heartworms fragile, so the body can break them down slowly over the next 8 weeks. Allowing vigorous activity at any time in these 8 weeks can cause the weakened heartworms to shatter, causing a clot of worm fragments that blocks off blood flow to the lungs, brain, or other organs (“shaking the tree” phenomenon). This causes a stroke or sudden death. Conversely, exercise restriction means the worms are slowly broken down by the body until gone, with no symptoms or problems.
Respiratory symptoms are important if you see them: if your dog is acting abnormally, develops a new cough, or has difficulty breathing, you should call your veterinarian promptly. These symptoms may be unremarkable, but often they are the first sign of a mild reaction to dying worms, requiring an immediate recheck visit.
Depending on each case, some dogs may receive oral cortisone tablets (prednisone), which you should give as directed. Other dogs may not need this treatment or only receive it on an as-needed basis if respiratory symptoms such as coughing occur.
You will be asked to return in 4 weeks for the next treatment series.
The second and third injections are given 24 hours apart, 1 month after the first injection. This means your dog will usually need to spend the night in the hospital for observation. This is the final treatment in the series.
When discharged after the third injection, your dog must remain as quiet/inactive as possible for the next 4 weeks, as noted above. After 4 weeks, limited activity may be slowly increased.
Respiratory symptoms are important, as described above.
Continue giving heartworm preventative on a monthly basis.
Afterwards
It is expected that with this approach, there will be no complications and you should see your dog acting, eating, breathing, and behaving normally during the treatment period. Should your dog exhibit any of the symptoms mentioned, call your veterinarian immediately.
If you will be unable to keep your dog confined during the entire treatment, you may discuss any alternatives that your veterinarian may have available. The risk of sudden death on exercise is so high that every option must be investigated.
Your veterinarian should re-test your dog for heartworm disease in 6 months. Your dog can slowly resume activity during this time. Remember to give all of your dogs a heartworm preventative monthly.
Alternatives and Their Relative Merits
Giving monthly heartworm-prevention drugs may gradually kill adult heartworms. However, they do so very slowly (1-2 years), and the race between slow worm death and the damage they are inflicting before they die continues. The purpose of injectable heartworm adulticides is a more rapid and complete elimination of the heartworms.
Frequently Asked Questions
Why do I have to give an antibiotic? Aren’t the injections enough?
Doxycycline, the antibiotic of choice, has greater effect than any other antibiotic in the treatment of heartworm disease. It kills an organism,Wolbachia, that lives inside heartworms and on which the heartworms depend. Thus, doxycycline weakens the heartworms and makes them more vulnerable to the adulticide injections. It is imperative to give the antibiotic treatment the entire time recommended by your veterinarian, barring symptoms of intestinal upset (loss of appetite, vomiting, which warrant a call to your veterinarian).
Why is exercise restriction so important?
When the worms are dying off, the worm bodies circulate in the blood stream. Increased activity increases the blood pressure and circulation, which can cause an embolism, or blood clot, in the vessel. This can cause a stroke or sudden death.
How did my dog get heartworm disease?
Heartworms are carried by mosquitoes. An infected mosquito bit your dog, depositing the worm in the tissues.
Do the heartworm adulticide injections hurt?
No, the injections are painless. About 20% of dogs develop inflammation over the injection site 2-5 days after injection, which creates soreness. If this appears to be the case, please contact your veterinarian.
Can I get heartworm disease?
There have been reports of humans developing heartworm disease, possibly as a result of immunocompromised in the human. These reports are extremely rare, and having a dog with heartworm disease does not pose a significant risk to immunocompromised or immunocompetent people under normal conditions. The risk for all mosquito-borne diseases should be reduced through basic mosquito-control measures (water buckets should be emptied, areas of standing, uncirculated water should be drained, etc.).
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How to Administer Subcutaneous Fluids to a Cat
How to Administer Eye Medications
Background
If your pet has sustained an eye injury, has an eye infection or an internal medical condition that is affecting the eyes, or is recovering from eye surgery, it may be necessary for you to give one or several medications into the eye(s) to help with healing. At first the idea of one person giving eye medications to a wiggly pet may seem like a daunting task, but it is possible. Practicing the following approach should help you safely deliver the recommended eye medications into your pet’s eyes.
Getting Started
Depending on the severity of the eye problem, one or more medications may have been prescribed for your pet. The first step in handling eye (“ophthalmic,” “ocular”) medications is understanding how much of each medication to give, when to give them, and which ones (if any) should be refrigerated. This information is on the label of most eye medications and can be explained to you by a veterinary technician if it is unclear.
It is common to be required to give eye medications from 1-8 times daily, equally spaced apart over time throughout the day. In some situations, continuing a schedule through the night may be important in the short term to prevent progression of an injury or infection and to potentially avoid eye surgery. In these situations, you should discuss with your veterinarian what the best schedule is before your pet leaves the hospital.
It is also common to need to place an Elizabethan collar (E-collar, “lampshade”) on your pet. This simple device can be tremendously helpful in protecting the eye from your pet’s desire to rub it, especially once it starts to heal and becomes itchy. These collars provide the best protection when they are worn 24 hours a day, since it only takes a few minutes to damage delicate tissue that has taken days to heal.
With medium- or long-nosed dogs, an E-collar can be kept on when administering eye medications, but with short-nosed dogs and many cats, it is easier to remove the E-collar and then replace it after giving the medication.
Troubleshooting Beforehand
If your pet is extremely energetic or has a small face or short snout, it may be more difficult for you to get medications into the eyes. At first, it may be helpful for you to have a second person available to help hold the pet still.
If you are applying more than one kind of drop, or both ointment and drops, then be aware of timing and order of administration. Drops are always first, and ointments are always last; otherwise the ointment can create a barrier that prevents the drops from working. To allow absorption of each medication, it is ideal to leave 5-10 minutes between giving each medication.
Allowing for extra time in your daily routine to accomplish this type of schedule is almost always necessary. In some cases, this is temporary (if the injury or disease is cured), whereas in other cases this type of treatment continues long term or permanently. You can ask your veterinarian about what is expected in terms of having to continue to give ocular medications.
Procedure for Administering Eye Medication
First, situate yourself so that you can hold your pet’s head. For cats and small dogs, this means putting them on your lap or placing them on a table. For medium and large dogs, this means kneeling down or arranging them so their hind end is between your knees or ankles while you are standing. This approach should also help keep them still.
Second, lift your pet’s head so the eyes and nose are pointing as straight upward as possible, ideally towards the ceiling. For a right-handed person, this is done using the left hand.
DROPS: Hold the bottle or dropper like a pencil in your right hand, and use the edge of your right palm to slide back the skin above the upper eyelid. This will lift the upper eyelid and expose the eye. Use the middle finger of your left hand, which is still elevating the chin to keep the head pointing towards the ceiling, to draw down the skin below the lower eyelid, further exposing the eye. Without allowing the applicator tip to touch the surface of the eye, bring the bottle/dropper close to the eye, and squeeze the bottle such that the correct number of drops of the liquid medication falls onto the eye surface.
OINTMENT: Using the same approach described for drops, squeeze approximately a 1/4-inch strip of ointment from the tube, and drape this strip of ointment across the surface of the eye, again taking care not to touch the eye with the applicator tip.* When finished, close the eyelids, and gently massage the strip of ointment over the surface of the eye.
*An extra precaution is to elevate the third eyelid. To do this, simply place gentle pressure with the tip of your left middle finger (which is helping hold the lower eyelid down) on the skin below the eyelid. This pressure on the skin of the eyelid, directed inward into the eye socket, elevates a membrane that rises across the eye: the third eyelid. The advantage of doing this is to further protect the surface of the eye from any contact with the tip of the ointment tube, in case of a sudden head movement.
Some surgeries to the eye require that the lids are temporarily secured closed with sutures (stitches). Some infections or traumatic injuries cause massive swelling to the eyelids. In both these cases, sometimes only a small portion of the eye can be seen. Often, the visible portion of the eye is the corner near the snout. In giving eye medications in these situations, the approach described can still be used, but the drops or ointment are placed in the corner of the eye. Drops should run across the eye (under the eyelids) easily on their own. Normal movement of the eye will help distribute ointment.
Afterwards
If you find that it is only possible to give eye medications by first removing your pet’s E-collar, be sure to protect the eyes from rubbing against the collar when you remove or replace it. For example, if you slip the collar over their head without taking the collar completely apart, you should hold your hand over their eyes as you slide the collar back into place. This will help prevent damage to the eye(s).
Frequently Asked Questions
Each morning my pet’s eye has dried discharge on it. Is that a problem?
A small amount (dry rice grain size or less) of black or yellow material is normal. Larger amounts are common with recovery from infection, traumatic injury, or surgery. If it is dried and caked, it should be removed to prevent a deeper infection. Hold the corner of a clean washcloth soaked with lukewarm water on the dried material to help it soften. Then gently wipe it away.
My pet had an infection in one eye, but now the other eye looks red/itchy/has discharge. What do I do?
This could be evidence that the infection has spread to the other eye. However, there are other explanations (such as allergy flare-ups) that can masquerade as a spreading infection. You should call your veterinarian or schedule a recheck appointment to determine the appropriate treatment.
I simply cannot get the medication in the eye. My pet shakes away, and I’m afraid I’ll cause more harm than good. What do I do?
There are some oral medication substitutes (syrups, tablets, etc.) and some injections that can help with certain eye problems. Above all, the first rule is to do no harm: if you are concerned you may hurt your pet—or may get hurt (e.g., bitten)—then do not administer the medication, but do call your veterinarian back the same day to make an appointment and review whether there is a different technique, or a different form of medication altogether, that is preferable.Type your paragraph here.Type your paragraph here.
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How to Assemble and Use an Elizabethan Collar
Background
Elizabethan collars (“E-collars”) are lampshade-shaped devices a dog or cat wears around the neck to protect its own tissue from self-trauma during healing. Commonly an E-collar is worn after surgery to keep the animal from licking, chewing, or otherwise disturbing the area of the body that was operated on. A dog or cat’s licking, contrary to popular myth, is not helpful but in fact delays tissue healing and favors infection. Other common uses of E-collars include protecting bandages or dressings that cover wounds and during treatment of ear infections or facial lesions to protect these areas from being scratched with a hind paw.
Getting Started
There are several different types of E-collars available. Generally these can be acquired at a veterinary hospital or a pet supply store. The two most popular types are:
Plastic (clear, white, or grey): These are thick, durable, multipurpose E-collars. Owing to their strength, they provide the best protection. They are also easy to clean. Before construction, these look like a half-circle of plastic with open square notches along one end and slits along the other end. Tabs face the center of the half-circle. When assembled, they are cone shaped and are held in place with a loop of gauze around the neck. There are variations of this type of E-collar that are secured with Velcro or metal stud-type buttons.
Thin, waterproof paper (blue): These are shaped like a satellite dish and are soft, pliable, lightweight paper collars that are appropriate for pets that do not vigorously attempt to reach around them. A major advantage is that they do not hurt when the pet collides with a person’s legs, nor do they have as much potential to cause damage to doorways or furniture as the hard plastic collars. With a strong and determined dog or cat, however, these paper collars may not be sturdy enough (destroyed with a few strong scratches or chews). These large paper collars are simply secured with fabric laces around the neck.
Troubleshooting Beforehand
All types of E-collars are available in various sizes and should be sized appropriately. An E-collar that is too big can easily slip off, whereas one that is too small can irritate or even cut the skin around the neck or interfere with breathing. A properly sized E-collar is comfortable and effective at blocking self-trauma.
The main points to watch out for when placing the E-collar on a dog or cat (either for the first time or if it has slipped off) are:
Make sure the E-collar is properly assembled and clean.
When putting the plastic E-collar together, don’t worry about whether it is inside-out or right-side-out (same thing).
Make sure plastic tabs and any other protruding parts don’t poke the pet’s eyes or ears while you are slipping it over the face and head. With hard plastic collars, you should firmly bend the loops that hold the string or gauze (which will tie the E-collar in place around the neck) outward, away from the hole for the head, for easier passage of the collar over the face.
Make sure the string or gauze that will be tied around the neck is loose and is kept away from the pet’s mouth when you slip the collar over the face and head.
When putting the E-collar on the dog or cat, there should always be one hand on the animal and one hand holding the collar. A common pitfall to avoid is to try putting an E-collar on a dog or cat by holding just the collar, not the animal. Holding the E-collar by the outer edge with both hands in an attempt to thrust it through and over the head in one quick motion is likely to frighten, annoy, or injure the pet and is not recommended.
Make sure it is long enough to accomplish the goal of an E-collar: the length of the collar, when resting as far back on the neck as the pet’s shoulders, should still extend past the tip of the pet’s nose.
Procedure: Placing the E-Collar on Your Pet
This procedure assumes the E-collar is already assembled, meaning it is cone or dish shaped. If it is not (i.e., it is a flat sheet of plastic), see below for assembly.
Sit or stand beside your dog or cat. For a right-handed person, be on the pet’s left side. Both of you should be facing in the same direction, meaning the pet is along your right thigh. Face to face does not give you control and challenges the pet to escape.
Pick up the E-collar by the edge, at the large end of the cone, with your left hand.
Reach around with your right hand to the right side of the pet’s head, and hold the side of the head (cats, small dogs) or the side of muzzle (larger dogs).
Guide the nose and head through the smaller end of the E-collar as you slide the cone to sit in place, past the ears and around the neck.
For cats, it can be helpful to use your right elbow to create a nook with your right thigh (when you are sitting on a couch to do this, for example) that restrains the cat’s hind end, preventing the cat from backing out and away.
Likewise, keep the edge of the collar out of the cat or dog’s mouth by keeping the pet’s mouth closed with your right hand and pointing the nose through the hole of the E-collar. In other words, one hand takes the whole head (cats, small dogs) or just the muzzle (bigger dogs) and guides it nose first through the opening in the E-collar until the back edge of the collar has come to rest well past the ears.
Tie the string or gauze in a shoelace-type knot, snugly but not too tight. You should be able to slip two or three fingers comfortably between the neck and the tied string/gauze.
Procedure: Assembling the E-Collar
When the collar is already in a cone shape, see above.
If you need to assemble the hard plastic E-collar (new—flat sheet of plastic in the shape of a semicircle):
First identify the edge with the open square holes and the other edge with the slits. Note that on one edge, there are two or more parallel rows of slits. In step 3, you will need to choose the appropriate row of slits to create a collar that is the correct size.
Bend the collar into a cone shape such that these edges overlap. The square holes on one edge of the collar should lie on the outside (convex surface) of the cone on top of the slits on the other edge. To assemble the collar, the square holes and the slits will be held together by weaving a long plastic strip through them.
Since there are two or more parallel rows of slits, this is the opportunity to size the E-collar properly. Choose an amount of overlap (i.e., a particular row of slits) so that the hole for the neck is just large enough to allow the E-collar to pass over the head and ears snugly.
With the square holes lined up with the chosen row of slits, you can now use the long plastic strip to weave the two edges of the collar together in overlapping fashion. Bend the long strip of plastic to the outside (convex surface) of the collar, and slip it through the closest square hole and the first slit beneath that hole. Pull the strip all the way through into the concave part of the collar. Then feed the strip through the second slit and back through the same square hole, and pull the whole tab through to the convex surface of the collar. Pull firmly on the long strip to firmly seat the edges of the collar together; there should be two small plastic “shoulders” that prevent it from feeding too far in. You should now have the long strip forming a loop then diving into the collar and back out again, binding the two edges of the collar together at that point.
Repeat this “weaving” process with the second and third square holes (and their underlying strips) to fasten the edges of the E-collar together at three points and make a solid, firm cone.
To make loops for the gauze ribbon or lace that will hold the E-collar in place around the neck: curl each of the three or four small tabs toward the convex surface of the collar, and push each one first through the bottom slit (pointing it to the concave surface of the collar) and then back out through the second slit.
Afterwards
When removing the E-collar, be sure to protect the pet’s eyes when slipping it on or off.
Frequently Asked Questions:
My dog is bumping into everything with the E-collar. Is there anything else I can use instead?
Ask your veterinarian if it is an option to change E-collar types. For a strong dog, motivated to get to the protected area, a larger, stiff, foam collar (like a neck brace) may work best. Alternatively, the blue paper E-collar may be an option.
My dog/cat manages to pry the E-collar off all the time. How can I get it to stay on?
With the help of a veterinary technician or veterinarian, you can select an E-collar size that is a very snug (but not excessively tight) fit. This size will not fit over the dog/cat’s head. Therefore, you place it on your pet by assembling it as for new E-collars (above), but already in place around the neck so it cannot be removed by the pet.
My other pet is licking at the protected area. What can be done about that?
First, observe closely to be sure that the other pet is doing the licking and not the pet wearing the E-collar. Dogs and cats can be very good at getting past the end of an E-collar that is too short. Replace the E-collar with the appropriate size if necessary. If the other pet is doing the licking, then these pets should be separated to allow time for proper healing.
Can I just make one of these at home?
Commercial E-collars are made to be the proper size, durable, lightweight, easy to clean and keep in place, and comfortable. Homemade versions (made from a bucket with a hole cut from the bottom or from an actual lampshade) that were recommended decades ago are less safe and usually ineffective. They commonly cause injury (edges cut into the neck) and fail to protect the desired area.
My dog/cat doesn’t want to eat/move/play when wearing an E-collar. What do I do?
In order to function properly at blocking chewing and licking, E-collars have to be longer than the pet’s nose. Some dogs and cats may need help during the first day to learn how to pick up the E-collar and place it over the food and water dishes. Be patient while they are learning how to navigate through the house with their new accessory. It can be helpful to lift the bowls by hand, or to make them elevated by placing them on a box or other object. Ask a veterinarian or veterinary technician to check the size before considering alternatives to the collar. Discuss options like removing the collar while the pet is under constant observation during mealtime.
My pet’s neck and head are long and narrow—his E-collar slips right over his head. How do I keep this from happening?
A veterinary technician can demonstrate how to better secure the E-collar by looping gauze under the armpits and tying it to the collar portion.
What if I just leave the E-collar off? I should be able to keep an eye on things.
This is a gamble. Some pets don’t lick or scratch when the E-collar is taken off, but many do cause damage to the delicate tissues, and this damage can be done very quickly. Entire surgical operations have had to be redone because of tissue damage inflicted in 10 seconds of licking and chewing by a pet that removed an E-collar. For some situations, depending on the location of the area that is healing and the degree of risk, it may be possible to use light dressings or loose coverings (e.g., stockinette) at certain stages, and you can discuss this with your veterinarian as a better option than taking the E-collar off entirely or taking it off when the pet is under supervision.
How to Bandage a Lacerated Footpad or Torn Dewclaw
Background
Laceration simply refers to a cut, which can be a simple and superficial one or a deep gash.
The dewclaw is the claw on the inner surface of the paw, like the thumb in a person. Most dogs and cats have them on the front paws, and most dogs (but not cats) have them on the hind paws as well.
Pets may accidentally cut themselves on the paw when they are outside walking, playing, or hiking, resulting in a laceration or torn dewclaw. Although these injuries can appear serious because they are often quite bloody, they are easy to manage. Applying a bandage is easy to do and can be accomplished at home.
The goal is to stop the bleeding by applying gentle, constant pressure to the area. However, it is also important to ensure that the bandage is not too tight.
Getting Started
Equipment/materials needed (mostly available at many pharmacies and in first-aid kits):
Bandage tape
Telfa pad or similar nonstick gauze material (optional)
Clean, dry, new cotton bandage material. An ideal material is Kling-type stretchable roll gauze
Vetrap, Elastikon/Elastoplast, or Ace-type roll of bandage material
A sock, such as a plain terrycloth white sweat sock, can make a useful external covering.
Troubleshooting
If the bleeding is heavy, it is most important to place a bandage on the foot to control the bleeding. You can then transport your pet to the veterinarian for evaluation. If the bleeding is light, you may clean the wound with an antibacterial soap or a diluted disinfectant solution (Betadine or chlorhexidine are commonly available at pharmacies; dilute 1 part disinfectant to at least 10 parts water before using). Rinse well with lukewarm water, dab the area dry, and apply the bandage. Tape will not stick to a moist haircoat; be sure to dry the area well.
If your pet resists, discontinue the procedure. Place a sock on the foot if needed and proceed to your veterinary hospital. Do not put yourself in harm’s way or allow yourself to be bitten.
Procedure
Apply a long strip of bandage tape directly to the skin/haircoat of the affected paw, but not on the wound. This strip should begin at least 6 inches (15 cm) up the paw and extend past the tips of the toes for at least 9 inches (22 cm). This will act to anchor the bandage to the hair and skin.
Apply a Telfa pad, if available, over the laceration or torn dewclaw. This allows for easy bandage removal.
Apply a layer of cotton bandage material. Start at the tip of the toes and work your way past the laceration in a spiral (barber pole) pattern. Each loop around the leg should cover 50% of the previous loop of bandage so there is good overlap and no gaps.
Apply a layer of Vetrap, Elastikon/Elastoplast, or an Ace bandage in similar fashion. Again, start at the tip of the toes and work your way up the leg past the laceration.
Very important: make sure the bandage is not too tight. If you are applying Vetrap or Elastikon/Elastoplast, prestretch the material by unrolling the whole roll first, then rerolling it before applying. Otherwise, the tension of unrolling the bandage while applying it will create too much tension and cause a squeezing effect on the leg that can deprive it of circulation. As a test: you should be able to insert a small finger under your bandage at the tip of the toes. If not, it is too tight.
The length of tape you applied in the first step will continue to stick out past the toes and is not covered by the bandage.
If the laceration affects one of the toes, the bandage should cover it but leave at least one or two other toes on the same foot clear of the bandage. These will be useful for checking that the bandage is not too tight.
Reflect/turn back the long piece of tape protruding from the toes, and apply it up the leg onto the bandage. This will help prevent the bandage from slipping off the leg.
Apply additional tape as needed to strengthen the bandage if necessary.
Afterwards
Always assess your pet's foot for any swelling. The toes should remain exposed past the bandage (exception: toe[s] that is/are lacerated) and will be the first to swell if a bandage is too tight. If the toes swell, remove the bandage and start over. Ensure that all layers are loose enough to prevent this type of swelling (which indicates poor circulation) but not so loose that the bandage slips off.
Your veterinarian may request that you continue to apply bandages to the area for a few days. Make sure the area is always clean and dry prior to bandage application.
If your pet will be going outside, cover the bandage with a plastic bag to prevent any moisture from getting onto the bandage. If the bandage becomes wet, you should change it. Wet bandages promote infection and gangrene.
An Elizabethan collar (E-collar) may be required to prevent your pet from removing the bandage. Do not allow your pet to chew, damage, or eat the bandage. The E-collar must be long enough that the pet cannot extend his/her foot past it to chew on the foot. Make sure, however, your pet can obtain food and water with the E-collar on (such as offering food or water by elevating the bowls by hand). It is a common myth that a dog or cat’s tongue is “antiseptic,” when in fact the antibodies that do exist on their tongues are no match for the bacteria also carried in the mouth when licking a healing tissue site.
Frequently Asked Questions
Why does the area have to be dry before the bandage is applied?
The area should be dry before applying the bandage because moisture can become trapped in the bandage, which can house and incubate bacteria. Ask your veterinarian how long you will need to continue applying and changing bandages and if you should allow the area to air dry for a few hours prior to reapplying the bandage.
What if the swelling is due to the injury, not the bandage?
Injuries can cause swelling and may need to be examined by the veterinarian. If you have any concern, call your veterinary hospital.
Should I apply an antibiotic cream to the area?
Not all lacerations need to have an antibiotic ointment or cream applied. Ask your veterinarian before you apply anything, as this may delay healing.
Should I wear gloves when cleaning the area?
Yes, you should always wear gloves when working with any wound. This will prevent you from becoming contaminated with bacteria and will prevent you from contaminating the wound.
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