How I got a chance to fix a baby coyote!

I recently had the unique opportunity to fix a 2 month old coyote baby!

A 2 month old coyote baby

One of my referral clinics is heavily involved in wildlife rehab.

Mama coyote had been hit and killed by a car.

Her two orphans were eventually found.

One pup, promptly named Lukas, had sustained a fracture of the right humerus, the bone in the arm, which required surgery.

Fractures in Lukas' arm
Fractures in Lukas' arm

Preop blood work showed that he was healthy enough to undergo anesthesia.

There were 3 main risks to be aware of:

. Surgery is challenging because of puppies’ bones are soft, so they don’t hold screws very well.

. Pediatric patients who undergo anesthesia are at risk for hypoglycemia (low blood sugar), hypothermia (low temperature) and hypotension (low blood pressure).

. It’s much tougher to rehab a wild animal than a tamed house pet.

Fully understanding the risks, we put baby Lukas under anesthesia.

Baby Lukas under anesthesia

What we couldn’t know before doing surgery, since scar tissue is not visible on X-rays, is how old the fracture was. It turns out that it had been a while. And that makes sense: by the time the terrified pup was found, rescued, assessed, transferred to the vet clinic, and then transferred to my care, it had been many days.

Another proof that the fracture was old is that his range of motion was very poor, even under full anesthesia (my exam notes said “Poor range of motion preop: cannot flex elbow beyond 45 degrees”).

My surgery report said “TONS of scar tissue… very difficult to recognize the anatomy of the bone.”

So we did what we could: stabilize the fracture the best we could, since lining up the bone was not possible. The result is not pretty on X-rays, but functional…

The repaired arm
The repaired arm

A stainless steel plate and 8 screws were placed.

Fortunately, Lukas recovered smoothly from anesthesia.

Dr. Zeltzman and Lukas

Despite the above challenges, the benefit of being young is that bones heal very quickly.

The next challenge was to allow Lukas to heal, confined in a small area, fed a healthy diet, while doing physical therapy so his elbow wouldn’t get too stiff.

All of that, while handling him as little as possible. It is very detrimental to overhandle wildlife, especially pediatrics, due to the risk of human imprinting.

Imprinting refers to a critical time in young animals when they form attachments and develop their identity. So they need to “imprint” onto their mother, or their siblings, or their buddies, not humans.

To avoid this risk, Lukas was eventually transferred to a rescue association.

Once fully healed based on 6 week X-rays, Lukas was reunited with his brother. They were kept at the rescue until they were 6 months old. Then they were released together, to live their coyote lives…

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

www.DrPhilZeltzman.com

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!

Pain is not acceptable

As a surgeon, my goal is to eliminate pain as much as humanly possible.

Let’s go over a few stubborn myths related to pain in pets.

Pain medications

1. My pet doesn’t cry out

“My pet is not crying and therefore is not in pain” has to be one of the most stubborn myths vets face on a daily basis.

When a pet limps or favors a leg or doesn’t put full weight on a leg, they are most likely in pain.

When a pet’s activity decreases, they may be in pain.

When a pet’s routine or habits change, they might be in in pain.

When a pet’s appetite decreases, they could be in in pain.

The fact is, most pets, especially cats, do not cry out when they’re in pain. Of course, if you step on their foot, they will cry out in pain, but that is short-lived because of what we call acute pain. Long-term, ongoing, continuous, sustained pain is called “chronic” pain.

Similarly, a dog may cry out in pain when (s)he initially tears a ligament, such as an ACL. But then the pain becomes subtle or low-grade and there’s typically no more crying.

Yet as long as they’re limping, it means that pets are in pain.

It’s the same idea as when you have a pebble in your shoe. You will shift weight to the other leg to decrease the pain. But as long as you put weight on the foot with the pebble, there will be some degree of pain.

Pain in cats is even harder to assess than in dogs. Cast tend to change their habits: less grooming, less jumping up or down, decreased appetite, hiding, fewer interaction with humans, withdrawal.

2. My pet is just old

Age seems to be the catchall excuse for multiple ailments. For example, urinating in the house is often blamed on old age, even though a bladder infection or bladder stones ( https://www.drphilzeltzman.com/blog/?p=1841) might be present.

When it comes to a pet’s decreased athletic ability – unwillingness to play, using stairs or jumping on furniture – many pet owners believe that age is the culprit.

Before we get to that conclusion, it’s important to make sure your pet doesn’t have a torn ACL, or severe hip dysplasia, or a bulging disc.

A painted picture of a dog

3. Pets don’t feel pain like we do

Some people still think that pets don’t feel pain like we do. Yet mammals have the same type of nerve endings, pain pathways and pain perception center in the brain as humans do.

To think that an animal in pain doesn’t deserve the same kind of treatment as humans is simply wrong.

4. There’s nothing we can do

Some pet lovers are told that because one pain medication doesn’t seem to work anymore, there are no other options.

Yet there are almost always other options: other pain meds, surgery, physical therapy, acupuncture, weight loss etc.

If all options have truly been explored, then maybe it’s time to have a discussion about quality of life, but not until then.

When the end finally does come around, you can rest assured that you truly did everything possible.

5. Postop pain is beneficial

Vets used to say that postop pain is a good thing because it keeps pets quiet, and that helps prevent injury to the surgery site.

We now have a much better understanding of the implications of untreated pain.

In my surgery practice, we routinely use 4-6 different techniques to prevent and treat pain. The drugs and techniques are well known, it’s just a matter of using them.

6. Minor procedures don’t need pain medication

This is another stubborn myth. Even what seems like a minor procedure, like a neuter, a mass removal or a tooth removal causes pain and should be treated.

A painted picture of a dog

7. Pain medication in old or sick patients is dangerous

There are multiple pain medications we can choose from. Each drug has potential side-effects, for example related to the kidneys and the liver.

This is a manageable risk. It’s a matter of pros and cons. We can easily monitor consequences on kidneys and liver with regular bloodwork. In a healthy pet on an anti-inflammatory, bloodwork is typically recommended every 6 months. In a pet with kidney or liver issues, bloodwork can be performed every 3 months, or even more often.

Another strategy is to decrease the dose of “risky” medications, usually an anti-inflammatory, or stop it altogether. We can also replace it with other, safer pain medications.

8. My client won’t pay for that

Some vets are concerned that you can’t afford proper pain prevention and treatment.

There, I said it.

If that is your case, then you should discuss it honestly with your vet.

If not, then you should demand the best possible pain management for your pet.

9. Surgery causes pain

A few of my clients have declined surgery for this reason.

As a surgeon, I’m not naïve enough to ignore the fact that left untreated, pain will occur after surgery. Again, most of my patients benefit from half a dozen pain management techniques.

This includes IV medications, special IV fluids, local pain meds, pain medications by mouth, pain medication injected directly into joints, pain medication injection around the incision etc.

So being fearful of surgery because of the fear of pain does not make sense. We can prevent and treat pain. In fact, a common reason to do surgery is specifically to treat pain.

Think of a broken leg. One consequence of surgery is to decrease the pet’s pain.

So it is quite the opposite: surgery helps decrease pain and eventually, it eliminates it.

A dog with a leg in a sling

10. My pet is not in pain

With all due respect, I would argue that many pet owners do not realize how much pain their pet is before surgery. Why is that? Possibly because everybody (humans and pets) slowly got used to it.

Case in point, we recently did a Total Ear Canal Ablation (TECA) in a Cocker with severe ear infections.

TECA is a pretty invasive surgery that has a reputation for being painful. So we use as many pain medications as possible, as mentioned above.

The very next day, the owner sent an email with an update: “He had a few rough moments trying to get comfortable. But once we got him to take his pain medication, he fell asleep and slept through the rest of the night.

(…) He woke up like a new dog today!

You would never even guess he had surgery. He had a full appetite, and is walking around very alert and actually attempting to play which we are trying to discourage at this point.”

Keep in mind, this comment came from a very smart, attentive and loving pet owner. She is very in tune with her dog. She was surprised by how comfortable her dog was after such an invasive surgery and went out of her way to email me to acknowledge how much pain her dog must have been in before surgery. And how comfortable he was after surgery.

This is actually one of vets’ biggest frustrations. We know when a pet is in pain and it’s sometimes difficult to convince a pet owner that their pet is in pain.

By the same token, if you feel that your family vet does not believe you that your pet is uncomfortable or painful, then it is your absolute right to seek a second opinion until you find somebody who takes you seriously (here is a perfect example: www.drphilzeltzman.com/blog/joshuas-story-taking-pain-seriously).

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

We are extremely fortunate to have access to all kinds of pain medications and surgery options to make many pets more comfortable.

Here are 20 signs that your pet might be in pain

. Limping, favoring a leg

. Decreased social interaction, withdrawal

. Anxious facial expression

. Submissive behavior

. Decreased movement

. Decreased jumping (eg on the sofa, in the car)

. Difficulty doing stairs

. Decreased grooming

. Whimpering

. Howling

. Growling

. Guarding behavior (e.g. head shy)

. Aggressiveness, biting

. Decreased appetite

. Weight loss

. Self-mutilation (licking, chewing, biting an area)

. Changes in posture

. Dogs: constipation

. Cats: Changes in urinary/defecation habits

. Hiding

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

www.DrPhilZeltzman.com

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 risky is it to anesthetize super young pets?

Rosalina, a 3 month old kitten.

Lukas, a 2 month old coyote.

Pup, a 3 WEEK old puppy.

A grey kitten

What do these tiny patients have in common? They all needed a broken bone repaired. And they all super young.

Rosalina the kitten had a broken femur (thigh bone).

Lukas the coyote had a fractured humerus (arm).

Pup the puppy had a broken tibia (shin bone).

Their surgery was definitely challenging because of their soft bones. But the biggest challenge is really anesthesia.

Why is the risk of anesthesia in pediatric patients higher than in other patients?

Younger patients are at risk for hypoglycemia (low blood sugar), hypothermia (low temperature) and hypotension (low blood pressure).

Hypoglycemia

Younger patients have very little body reserves on board. So they are at risk for hypoglycemia (low blood sugar).

Patients who are old enough are often fasted at 8 pm the day before anesthesia.

In young puppies and kittens, we can’t do that, precisely to prevent hypoglycemia. Babies are typically allowed a small meal the morning of surgery.

Their blood sugar should then be monitored before, during and after anesthesia. If it’s too low, we can give sugar IV (in the form of dextrose) or by mouth (in the form of Karo syrup).

A puppy with a break high in the leg

Hypothermia

Another struggle is keeping very small patients warm. All patients rapidly loose body heat under anesthesia. Super young patients are an even bigger challenge.

Of course, the solutions are well-known: warm air blankets, warm water blankets, IV fluid warmers etc.

These warming devices actually need to be put in action early and systematically to keep your pet safe.

An anesthetised fox with a broken leg

Hypotension

Our pediatric patients may also have trouble with low blood pressure as a side effect of anesthesia.

Low blood pressure can be very dangerous if not corrected. Blood needs to appropriately move through the body to carry oxygen to all vital organs, such as the kidneys.

Decreased oxygen makes just about everything unhappy. It’s so important, that we monitor all of our patients’ vitals, including blood pressure, so changes can be identified early and corrected.

A fractured leg

Blood work

Another way to decrease the risk of anesthesia is to run blood work. This helps us ensure that vital organs like the kidneys and the liver are healthy, and your baby can safely go under anesthesia. Of course, this applies to adults as well, and especially to seniors.

If the blood work does uncover an abnormality, it does not necessary mean that surgery will be canceled. However, it will often mean changing the anesthesia medications & postop pain medications used.

One specific thing we look for in young patients is abnormal numbers that could indicate an important condition called a liver shunt.

None of this information should change your mind about doing surgery. What it should do is educate you to make sure you and your vet can come up with the best plan for your baby, with the safest anesthesia and the smoothest recovery possible.

Hypoglycemia, hypothermia and hypotension are pretty straightforward to prevent when you are working with an experienced team. So don’t be shy about asking questions, so your super young pet is safe during anesthesia and surgery.

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

www.DrPhilZeltzman.com

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!

Who on earth wants surgery on their 23 year old cat?

I recently repaired a fracture on a 23 year old cat. Some of my nurses aren’t even that old! It’s a true story with a very happy ending.

Basil, the 23 year old cat, had a broken tibia. The shin bone was broken in 3 main pieces. He went to the local ER, where his owner was told that he was too old and should be put to sleep.

Basil, a 23 year old cat

That did not sit well with Basil’s owner. He may be 23 years old, but he was healthy otherwise, so why end his life? His owner contacted me regarding Basil’s situation. We agreed that it was ethical to perform surgery on him, since he was healthy otherwise, and we scheduled him for surgery.

A fractured leg

Fixing the shattered bone required 1 pin, 1 plate, 4 wires, and 9 screws to repair! A bone graft was added to speed up healing. Surgery went well and sweet Basil recovered smoothly under the close supervision of his nurses.

The repaired fracture

At home, he was strictly confined for 8 weeks. At suture removal, after only 2 weeks, he surprised everybody by walking around using the leg very well.

And after 8 weeks, follow up X-rays showed that the bone had healed nicely and we could start to increase Basil’s activity.

The repaired fracture

And after one more month of that, Basil returned to his normal Grandpa life.

So what’s the moral of this story?

As I always say, “Age is not a disease.”

A few conditions need to be met for surgery to be a valid option in my opinion:

. The patient should be reasonably healthy

. The condition should be fixable.

. Quality of life should be good after surgery.

. The owner should be 100% on board.

Two months after surgery, Basil’s owner writes: “My sweet 23 year old cat is finally back on the couch with me. He is getting giant hugs. He’s really doing great. I really have no words to thank you enough.”

I don’t see why we should deny help to a patient who fulfills these criteria.

Basil’s owner certainly felt that way, and I am sure Basil did as well…

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

www.DrPhilZeltzman.com

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!

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.

A dog wearing an e-collar

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.

A dog wearing an e-collar trying to lick itself

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.

A reopened 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.

A reopened 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.

A black dog wearing a collar

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!