E Collars and Your Pet- Cone of Shame or Best Friend?

Ah, the dreaded “cone of shame…”

After any surgery, we strive to send your pet home with an incision that looks as nice as possible. The plastic cone or E collar (short for Elizabethan collar) was created to prevent licking. Without it, licking or chewing can cause irritation and discomfort.

At best, that may leave a hairless, discolored, ugly scar – for life.

Or it could lead to an open incision, that needs another surgery to close it up.

At worst, it can cause a serious infection.

WARNING: some pictures below might be disturbing to some sensitive readers.

Despite the stubborn urban legend that animal saliva speeds up healing, licking an incision is a sure way to slow down healing. The tongue, especially in cats, is so rough, that it can destroy healing tissue, and therefore delay healing.

Depending on the particular pet or level of discomfort, licking can lead to nibbling and chewing, especially when nobody is around to watch or distract them.

Pets have an amazing inherited skill, which allows them to chew up twenty stitches or staples in less than two seconds flat. By the time you realize it, it’s too late!

Below is an example of a dog who was caught in the act. She went home with a cone that is too short, and does not prevent reaching the incision. Clearly, the correct fit is critical.

I cannot begin to count how many times pet owners have asked me if their pet really has to wear an E collar.

And I cannot begin to tell you how many clients thought their pet was different, or well-behaved, or well-trained, or smarter, and didn’t need a cone.

Or how many pet owners were in tears after their pet chewed the incision open after they removed the cone “for only 5 minutes” or “just to give him a break” or “because she looked so sad.”

Below is a (mild) example of what happens when a pet licks the incision.

I cannot begin to add up all the extra money owners have paid to fix open incisions at their vet or the emergency clinic.

And I cannot tell you how many clients swear that they will not leave their pet’s side for 2 or 3 weeks. Meanwhile, I’m pretty convinced that these clients will need to sleep, or go to the bathroom, or get a bite to eat. There is no such thing as 24/7 supervision with a pet!

Depending on how bad the damage is, treatment may require rinsing the open area, cutting out damaged tissue and re-stitching the entire incision. For a little bit of perceived freedom from the evil cone, clients sometimes end up spending more money in anesthesia, surgery and antibiotics to fix an entirely avoidable problem, not to mention the discomfort the pet goes through – and a longer recovery. And ironically, then the pet needs a cone for even longer!

Below is another (mild) example of what happens when a pet licks the incision.

Leaving the E collar on at all times is the best way to get your pet used to it. If you feel bad for your pet and take the cone off, then put it back on when you leave, your pet may take it as a punishment and may try to remove or destroy it.

Patients can absolutely eat, drink, walk, pee, poop, and sleep with a cone on. In fact, the stricter you are with the cone, the quicker they will get used to it. In addition, pets do not hold grudges, so they will not be mad at you for being strict with the rules.

Collars are not to “shame” pets or annoy owners, they are essential for quicker and better healing of the incision. Call it a necessary evil or a cheap insurance policy. Next time your vet recommends an E collar or a similar device, please follow their advice. It truly is in your pet’s best interest.

Moral of the story?

The plastic cone is your pet’s best friend.

Any surgery has complications. Some are not predictable. Licking an incision is totally avoidable. We know how to prevent that. Please trust us, and please be part of the solution.

Your pet, in the end, will thank you for it.

What about alternatives to the plastic cone?

Marketers spend a fortune trying to convince pet owners that their alternative is better than the hard plastic cone.

There are soft cones, hard cylinders, foam “donuts,” inflatable “donuts,” various covers and sleeves and more.

As a surgeon, I have witnessed what seems like every conceivable complication.

Experience has shown me that these options are not as fool-proof as the standard plastic cone.

A stubborn or itchy pet will lick around a donut or soft collar, we see it all the time!

Bitter Apple or similar product may be placed around the incision – not directly on it. However, this does not deter some pets at all. Some actually love the taste!

So again, the hard plastic cone is your pet’s best friend… and the cheapest insurance policy against licking.

Phil Zeltzman, DVM, DACVS, CVJ, FF certified

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

Should you wait to get help for your pet?

Your pet is vomiting. Should you wait to go to the vet?

Your pet is limping. Should you wait to seek help?

Your pet has a mass. Should you wait to have it looked at?

These are common dilemmas, and the answer is… it depends!

Let’s keep our 3 examples.

. Many pets vomit every once in a while, and they are perfectly healthy otherwise.

Other times, repeated vomiting is a sign that something is brewing inside. And it could be anything: stomach problems, intestinal conditions, kidney disease, cancer etc.

. Some pets limp because of a sprain and get over it by the next day, just like a human.

Other times, ongoing limping is a sign of a problem: elbow arthritis, hip dysplasia or the most common cause of limping: a torn ACL.

. Many pets have skin masses. Most masses can only do one thing: get bigger. Very rarely does a mass get smaller. It would defy science: as cells divide, which they are genetically programmed to do, the mass gets bigger. It can be slow or it can be fast, but they usually get bigger over time. The only way to objectively know what is going on is to measure it.

So what’s a pet lover to do?

Should you keep an eye on it?

For a short while, possibly.

Waiting any longer is rarely a good idea.

. Repeated vomiting can lead to dehydration and electrolytes imbalances.

. An untreated joint problem invariably leads to arthritis, which can only get worse over time.

. A small mass is easier, less invasive and cheaper to remove than a large mass. This translates to longer anesthesia, higher surgery fees and higher chances of complications.

Occasionally, you will be a bit early and it’s a false alarm.

Most times, you will be right and acting early will save you time, money and frustration while avoiding pain for your pet.

At the very least, call your vet to ask questions. Many vets now offer telemedicine consultations, which means you don’t even have to take your pet to the vet. You can get advice from the comfort of your home.

Just keep in mind that vomiting may require X-rays or an ultrasound, limping may require X-rays and a mass may require lab testing.

Either way, don’t procrastinate, it rarely leads to good results.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

How do I know if my pet is in pain?

This is a very common question… and it does not have an easy answer.

An entire book could be written about pain!

Instead of a book, here are some general, practical guidelines.

1. Limping

This is one of the most difficult message to convey. Yet it’s simple.

LIMPING = PAIN – 99% of the time.

2. Decreased activity

If your pet suddenly or progressively doesn’t play as much or as long as usual, it’s important to find out why.

3. Difficulty in stairs

To simplify, going downstairs puts more pressure on the front legs, so they may be the issue.

And going upstairs puts more pressure on the back legs, so they may be the source of the problem.

4. Changing habits

If your dog runs like a maniac to greet you when you come back from work every single time, and progressively or suddenly doesn’t, why is that?

If your cat loves napping on a window sill to enjoy the sun, every single day after breakfast, and doesn’t anymore, why is that?

If your dog loves going on a walk, or a run, or a bike ride, and doesn’t anymore, why is that?

5. Difficulty jumping

If your pet routinely jumps on the couch, or your bed, on in your car, or on a chair, and suddenly or progressively doesn’t as easily, it may be because of pain.

6. Difficulty getting up

Struggling to get up after a nap or in the morning, or stiffness in the legs, can also be a sign of pain or arthritis.

7. Change in appetite

Painful pets often lose their appetite, even for a favorite treat. It could be sign of pain in a leg (difficulty walking to you or to the bowl), or neck pain (reaching the bowl, which may need to be elevated), or pain in the mouth or in the teeth.

8. Not wanting to be touched

Pain can lead to “guarding” a leg or the belly, or becoming “head shy”. A classic example is a pet with ear pain or an ear infection (e.g. Cockers). Similarly, no longer wanting to be petted or picked up is a sign to take seriously.

9. Hunched position

A hunched position can be a sign of belly pain or back pain. Either way it can be very serious.

10. Reluctance to move a body part

This can apply to legs, and also to the neck. If your dog doesn’t like moving the neck up, down or to the side, and tend to look at you without moving the head, it can be a sign of neck pain.

11. Hiding

Cats are notorious for this. Either they hide, or they sleep in unusual places.

12. Grooming changes

Not grooming as much, or over-grooming or licking a particular body part can also be a sign of pain or arthritis.

13. Vocalizing

Crying or vocalizing may be a sign of pain, but PLEASE do not count on that to decide your pet is in pain. Many pets, if not most, will not cry when in pain.

14. Aging

Just kidding!

As I always say, “age is not a disease.” While slowing down can be normal, just like in people, limping or being in pain is not.

We can successfully treat countless conditions we were unable to help with before. You no longer have to accept your pet no longer playing or not wanting to go on walks because he or she is “just getting old.” It’s probably because they are painful or have arthritis. Both can and should be treated!

15. Off

Nobody knows your pet as well as you do! Sometimes, a subtle change, a gut feeling, a new routine, can give you an indication that something’s off.

Trust your instinct. Don’t brush it off. Ask yourself – or you vet – what this is happening. Everything happens for a reason in the pet world!

Here are a few more important points to keep in mind:

1. Hiding

Animals are very good at hiding when something is wrong. Remember, in the Wild, if an animal acts sick, they get eaten. Sadly, our pets have kept this ability. Cats are notorious for that.

2. Expression

Pain and its expression can vary dramatically from breed to breed, and from pet to pet. We know for a fact that some pets are more stoic, and others are more… “sensitive”.

3. Surgery

In my world as a surgeon, surgery is a classic way to help painful patients. Fixing a broken leg, repairing a torn ACL or removing a cancerous mass are just a few examples.

4. No surgery

But keep in mind that there are many ways to decrease or stop the pain without surgery including: weight loss, cold therapy, heat therapy, joint supplements, environmental changes, improving traction, acupuncture, harnesses, physical therapy, massage etc.

5. Warning

Please do NOT give any medication over the counter, or any human medication, or leftover medication from this or another pet, unless directed by your veterinarian.

Many human drugs are toxic to our pets, even deadly.

Something as “simple” as aspirin is a huge problem in a pet because:

1. We cannot give a better, safer, stronger anti-inflammatory drug for 7 days after stopping the aspirin and

2. If surgery is necessary, we cannot perform it safely for 7 days because aspirin thins the blood and increases the risk of bleeding!

ANY source of pain should be a reason to see your family vet or a board-certified surgeon.

As I always say, “pain is not acceptable.”

Pain should be taken very seriously – and vets are here to help you, help your pet.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

What Is Quality of Life For a Pet?

I frequently have difficult conversations with pet owners that revolve around quality of life.

Most recent examples include:

. Is it ethical to perform ACL surgery in a pet with cancer?

. Is it reasonable to perform surgery in a 13 year old dog with laryngeal paralysis (ie who suffocates around the clock)?

. Is it fair to amputate a pet who has non-operable cancer on a leg?

It certainly depends on the situation, but overall the answer is YES – for the right pet and the right pet owner.

Pets don’t need a vacation home, stock options or designer clothes.

What they do need is being able to eat, drink, breathe, walk, urinate, defecate, groom and sleep – all in a pain free manner. And hopefully, you can expect a little tail wag here and there from a dog and a happy meow from a cat.

This list is certainly debatable, I admit it. One could add that a pet should be free of loneliness, fear and boredom. But I think the short list is a good starting point when you consider medical conditions.

If any of these basic bodily functions doesn’t take place, or if it occurs with difficulty, discomfort or pain, then your pet has a decreased quality of life.

What can you do then? You need to start by having a serious conversation with your family veterinarian. Or a board-certified surgeon.

Questions that need to be answered are:

. Is my pet suffering?

. Why is my pet painful?

. How can we decrease the pain?

. Can medications help?

. Can surgery help?

Of course, you may not hear the real story, the truthful story, because some people may not be bold or upfront enough to tell you what you need to hear.

I regularly talk to clients whose cat has been beyond constipated for YEARS before they got help (surgery is the only realistic solution).

I regularly talk to clients whose dog has been struggling to breathe for months or even years before they sought help (surgery is the only realistic solution).

I regularly talk to clients who had been told that a skin mass is not a big deal, or that a mass cannot be removed… when it truly is a big deal, and it absolutely can and should be removed.

Of course, surgery is not always the only option, I’m much more objective than that!

If your dog limps, pain medications, surgery, joint supplements, weight-loss or a “joint food” might help.

If your pet has a hormone imbalance, medications may solve the problem. The list goes on…

How can you tell if your pet’s quality of life is changing?

One subjective but simple way is to use a scale from 1 to 10, 1 being the poorest quality of life and 10 being the best. If you rate your pet as a 9 in January and a 2 in May, then it is time to face the evidence. It’s time to have a heart-to-heart discussion with your family and your veterinarian about what can realistically be done.

For a more thorough & slightly fancier quality of life scale, you can visit

https://pawspice.com/quality-of-life-scale.html

If you are starting to wonder about your pet’s quality of life, here is my suggestion: print a few copies of the “HHHHHMM” Quality of Life scale. Then fill in one table regularly – monthly, weekly or even daily depending on the situation.

This will help you see a trend more objectively: is your pet’s status the same, better, or worse than last time you assessed the situation?

Remember this very important concept: “age is not a disease.” Just because a pet is 12 or 14 or 16 years old does not mean you should give up easily. That said, if neither pain management nor medical and surgical treatments can help, then maybe it is time to consider euthanasia.

As emotionally and ethically difficult as it is for a pet owner, the whole family, and the veterinarian and his/her staff, euthanasia is sometimes the only reasonable, humane solution. It may be the only way your pet finds relief.

Quality of life includes your pet’s right to stop suffering with dignity once all reasonable options have been exhausted.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!

Top 10 Reasons To Neuter Your Pet

Clearly today’s topic is sensitive and it will ruffle some feathers… but please hold the hate mail.

It never ceases to amaze me the number of cats and dogs who end up on my surgery table because they were not neutered. Many end up hit by a car. Many end up with a specific type of hernia (more below).

Then there are all the non-surgical reasons, starting with behavior problems.

Are you wondering whether you should neuter your cat or your dog? Here is a non-exhaustive list of 10 reasons to do it.

1. Unwanted pregnancies

Ah… Love at first sight… It’s really difficult for an intact male to resist a female in heat! An intact male classically runs away and can follow the smell of a pretty female in heat located miles away. And keep in mind that one single incident can lead to 4, 8 or 10 puppies or kittens!

Incidentally, you may be liable if your male procreates with somebody’s prized female. Suddenly, the miracle of life has a bittersweet taste, doesn’t it?

2. Pet overpopulation

Meanwhile, 3 to 4 million of unwanted pets are euthanized each year. What a tragedy… This is called “pet overpopulation”.

Many of these deaths could have been avoided by neutering males (and spaying females).

So sterilizing your pet ultimately makes the world a better place.

3. Behavior

Unneutered pets have all kinds of behavioral problems. In male dogs, the most common behavior is an aggressive temper. Of course, there are many intact pets who are perfectly sweet. Neutering, when done early in life, can reduce aggressiveness and improve behavior overall. For example, it decreases the always-awkward “mounting” behavior in dogs.

4. Marking

Few things smell worse than intact male cat urine. Some people make their indoor cat an outdoor cat when they can’t tolerate the smell anymore. This increases the risk of being hit by a car or getting into a fight. Neutering, when done early enough in life, virtually eliminates the odor of male cat urine and should prevent marking in male dogs.

5. Roaming and getting in trouble

Pets are rarely taught how to cross the street safely. So when they roam, searching for trouble or looking for a partner, they might get hit by a car.

In fact, many pets I treat for a fracture are intact. Neutering reduces the urge to roam or run away from home.

In addition, neutering decreases the risk of getting into a fight, especially in tom cats. They commonly get nasty abscesses from these fights.

Family and emergency vets regularly see wounds from dog bites, and I assure you that it’s rarely pretty. I’ve seen many dogs die after getting attacked by another dog.

6. Roaming and getting lost

Every year, millions of pets get lost. Some are returned to their owner. Most are not. To decrease the risk of such a tragedy happening in your family, neuter your pet, pet-proof the fence in your backyard and always keep your pet on a leash during walks.

In addition, talk to your vet about the benefits of tattoos and microchips.

7. Prostate disease

Intact male dogs can have a number of diseases of the prostate including cysts, abscesses and enlargement. The latter is called “benign prostatic hyperplasia,” just as in older men. Neutering (of dogs!) prevents these problems.

8. Perineal hernia

A perineal hernia is a fixable but annoying problem mostly seen in intact male dogs. Organs from the belly can slip or herniate through weakened muscles in the pelvis. The consequence is a bulge on one or both sides of the anus. The hernia can contain fat, fluid or even the bladder. These hernias frequently cause constipation.

This condition is believed to be due to testosterone (from the testicles). Neutering dramatically reduces the risk of these hernias.

9. Testicular tumors

Neutering eliminates the risk of testicular cancer. This condition, mostly seen in intact male dogs, is believed to be due to testosterone (from the testicles). It’s simple, really: no testicles, no testicular cancer.

One more reason to neuter is when a male is cryptorchid, i.e. when a testicle does not come down and remains in the belly. The testicle left in the belly has a much higher risk of becoming cancerous. So this may require 2 surgeries: 1 to remove the “outside” testicle, and 1 in the belly to find and remove the other one. Occasionally, both testicles are in the abdomen.

10. Genetics

Yet another reason to neuter is to prevent spreading bad genes. Pets with hip dysplasia, eye diseases, heart conditions and many other genetic conditions should not be allowed to breed.

It seems, however, that neutering does not decrease, and in fact may increase, the risk of prostate cancer. Luckily, this is a very rare tumor. Therefore, the combined benefits of neutering vastly outweigh the risk of prostate cancer as you can see from this top 10 list.

The next controversy is when to neuter your pet. Again, hold the hate mail: most reasonable vets recommend neutering at 6 months of age.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Dr. Phil Zeltzman

Dr. Phil Zeltzman is a traveling veterinary surgeon in Pennsylvania & New Jersey. An award-winning author, he loves to share his adventures in practice along with information about vet medicine and surgery that can really help your pets. Dr. Zeltzman specializes in orthopedic, neurologic, cancer, and soft tissue surgeries for dogs, cats, and small exotics. By working with local family vets, he offers the best surgical care, safest anesthesia, and utmost pain management to all his patients. Sign up to get an email when he updates his blog, and follow him on Facebook, too!