Just in time for Black Friday/Cyber Monday, Understanding Your Pet’s Labwork: A Guide to Communicating with Your Veterinarian is on sale for a limited time. Looking for the perfect holiday gift for the pet lover in your life? This unique reference book is designed for the discerning dog or cat lover who would like to understand in more detail what it means when your dog’s ALKP is high, or why imbalances in electrolytes are so concerning.
Empower yourself as a pet parent to ask the right questions when faced with certain test results, and have a better understanding of why your veterinarian recommends certain courses of action.
Veterinarians and veterinary professionals may also find this resource useful when explaining the implications behind certain test results, and open up a clearer dialog between you and your clients.
This is a reference book that can be used in many ways: as a resource when looking up specific test results, as a text to be read over time when you’d to know more how veterinarians view diagnostic testing, or if you’d like a simple analogy to explain how the kidneys or the pancreas works.
Understanding Your Pet’s Labwork has been discounted for this weekend alone, so grab your copy at this price while you can!
It’s a fact of veterinary medicine that sometimes we must muzzle our patients in order to have their cooperation and to protect the people handling them. This isn’t something we like to do as a matter of routine. For years, I’ve been using cheese and treats to make the vet experience positive for puppies and kittens, and many of those animals grow up being excited to see us.
But that method doesn’t always work. Farm dogs who only see a vet for the occasional rabies shot, dogs who have more important things to do and resist the notion of holding still, cats who never leave the house except when they are ill, animals that have had bad experiences elsewhere or are so terrified at the vet’s office they shut down, unable or unwilling to accept rewards–these are challenging patients. As are the aggressive patients or undersocialized patients: the feral tomcats, flock dogs that have never seen the inside of a building, animals who believe a good offense is the best defense.
It doesn’t help that the veterinary profession has been under a lot of strain for years–and only just now are getting the recognition of this fact. Job burnout is high. Clinics are chronically understaffed, staff members are chronically overworked. The job itself is fraught with emotional, physical, and mental stress. The veterinary profession must deal with what researchers call “the caring-killing paradox“, in which we are sometimes forced to end the life of a patient we’ve been taking care of since it was a puppy or kitten, even though this may be the humane, necessary, or only viable option. Clients blow up at staff members, accusing us of “only being in it for the money” when the costs of practicing high quality medicine are often outside our control and because if we can’t afford to pay our staff and our bills, we won’t be there for your pets. Cyberbullying has a huge impact on the mental health of those in the profession. Professionals have been literally threatened–even killed–by disgruntled clients. The suicide rate among female veterinarians is 3.5 times the national average, and male veterinary technicians are five times more likely to commit suicide. According to the CDC studies, one in six veterinarians has contemplated ending their lives.
As one article I read said, “You’re always failing someone.”
In the past, I have worked in practices where appointments were booked every 10 minutes, and the emphasis was on getting things done and staying on schedule. There is very little time in situations such as these to accommodate a fearful or aggressive pet. Thank goodness, by far and large, the profession has moved away from this model!
But often, it’s not a simple matter of slipping a muzzle on the animal and presto! You can suddenly draw blood samples or palpate a tense abdomen. Sometimes, even the most competent professionals cannot get the animal safely contained.
Fortunately, with the advent of Fear Free training and the emphasis on fear-free veterinary experiences, we’re seeing the tide turn when it comes to restraint practices. This often means using what we call the “chill protocol” (a combination of anti-anxiety and calming medications) prior to the vet visit, which not only brings the fear levels down in the patient, but also in the people who have to handle them in the clinic. We still have to use muzzles and restraint methods on many of these pets, but everyone is much calmer. This not only facilitates drawing lab samples, but performing physical examinations on some animals that will not allow anyone except their owners to touch them. If your veterinarian suggests something along these lines, please understand we are trying to create a more positive experience for all concerned.
Many of the patients we’re seeing now were pandemic puppies and kittens–an entire generation of undersocialized animals who saw only their own people during lockdown. While I wouldn’t wish this on any of us, one of the good things to come out of this is the recognition that something needs to change when it comes to handling such fearful pets on a regular basis.
But we still have pets who freak out when muzzled–an apparent panic attack–even with anti-anxiety medication on board. It wasn’t until an experience at the dentist several years ago that I figured out why. Like some animals and vet visits, many of us have a fear of going to the dentist. We’ve felt extreme pain, or our jaws ached for days after having work done. I don’t like going myself, despite the fact I have an outstanding dentist. (In fact, I drive almost an hour to see him because I trust him when it comes to painful procedures).
At that time, I had to have an impression mold done for some dental work I needed. This required filling a tray with what seemed like Silly Putty and having me bite down on this until the jelly-like mass filled my mouth. Then I had to sit there for several minutes, breathing through my nose, while the molding putty hardened. The glutinous mess filled my oral cavity and pressed on my upper palate. It obstructed the back of my throat. And while I labored to pull air in and out of my chronically inflamed, allergic nasal passages for those two minutes I had to endure the process, I gripped the armrests of my chair until my fingers ached and drummed my heels on the seat, all the while my adrenaline surged. I thought I was going to die.
I came away from the experience understanding why some dogs flip out when they are muzzled. See, the type of muzzle most often used in vet med is a nylon or mesh muzzle which holds the mouth tightly shut. Dogs cannot pant wearing this type of muzzle. We can only leave it on for brief periods of time, as the patient is at risk of overheating. It’s not the sort of muzzle for home use, and so animals learn to associate it with vet visits as well. There are different muzzles designed for the flat faced breeds and cats, but I’d observed that some animals with regular snouts didn’t breath well when muzzled (so we worked very fast).
My experience at the dentist changed everything. Now I got it. I really got it. Some muzzled animals believed they were going to die.
The first thing I did was begin instituting the use of basket muzzles for those highly fearful dogs that needed to wear a muzzle for their entire visit. These are plastic or wire muzzles that allow the patient to open their mouths, pant, drink water and accept high-value treats but not bite. (I prefer the plastic ones for veterinary use because getting punched with a wire muzzle still hurts a lot!)
The difference in some dogs was amazing. They still weren’t happy about their vet visits, and most still needed medication to make things easier for everyone involved. But that level of panic that would make us abandon further attempts to perform our exam, draw blood, etc. wasn’t there. Best of all, clients could order their own muzzles and practice habituating the dogs to them at home. They could arrive wearing a basket muzzle because overheating wasn’t an issue. And we didn’t have to start our visit trying to corral a patient into wearing a safety device. Frankly, I wish I’d instituted basket muzzles sooner.
The brand I recommend most often is made by Baskerville. They are well constructed and come in a variety of sizes. (The one linked here is for a medium sized dog–make sure you read the specs before ordering any for your own dog). I recommend placing a little squeeze cheese or peanut butter inside the muzzle and encouraging your dog to place his snout inside, holding it in place for short periods while he gets his treat, and gradually working up to buckling it on and having him wear it for longer increments of time at home. This is the sort of training that needs to be done well in advance of vet visits. But training your dog to wear a muzzle and the use of the chill protocol can ease the trauma of vet visits for these pets–and it is a trauma to them. But having less terrifying experiences over time lessens the fear and aggression for many of these dogs, and these visits become less traumatic for everyone.
I recently had to have an emergency root canal. I told my dentist up front about the fact I didn’t breathe well through my nose and the panic that ensued when I thought I couldn’t breathe. He took these things into consideration, and we arranged a sort of “safe signal” so I could tap out when I needed a break. We got through the procedure, even though I wouldn’t wish it on even my worst enemy. Afterward, speaking slowly in an attempt to enunciate with half my face numb, I told him what I’d learned at his hands.
He laughed. I’m sure he’ll be dining out on that story in the future.
Recently, I had a client come in with her senior dog, concerned because he wasn’t eating with the same enthusiasm as he did before. This is not uncommon in senior pets, and can be rooted in medical problems, which should be ruled out. But after determining that her dog’s lab work was normal (CBC, chemistry panel, urinalysis and fecal), and performing a complete physical to rule out underlying conditions that might affect his appetite, such as heart disease, or dental disease affecting his ability to chew, we came to the conclusion that her dog Sonny simply needed more supportive care around the house.
Not all that long ago, I took an online seminar on aging pets with speaker Dr. Mary Gardner, and I was pleased to find out I was already implementing many of the things she suggested in her talk. So the first thing we looked at was Sonny’s feeding arrangements.
It turns out his owner was using a slow feeder bowl for Sonny because he used to gulp his food ravenously. Hey, I’ve been there! My previous German Shepherd definitely needed a slow feeder bowl, but when I got my current dog, it took him over an hour to eat his dinner out of the same bowl! Clearly Captain didn’t need a slow feeder, and likewise, Sonny didn’t either. The needs of your pet can change over time. Most likely, Sonny found getting food out of the slow feeder bowl too challenging, and as a result, gave up on eating while there was still food left.
Another thing we observed in the exam room was that Sonny had mobility issues on slick floors, and seemed to have difficulty lowering his head to eat and drink while maintaining his balance. Many dogs are less active with advanced age, and the hair on the bottoms of their feet can grow excessively long, acting like little slippers on slick surfaces. Sonny definitely had fuzzy feet, so we shaved the bottoms of his paws between the pads to help with traction. Dogs who get groomed regularly usually get this treatment, but Sonny had never been groomed before. I suggested to his owner that she invest in a small cordless trimmer like the one we used in the clinic.
I also like to make safe pathways through the house and around feeding stations. Yoga matting can be ideal for this situation. You can even purchase it in commercial rolls to cut to the size needed.
If altering the flooring situation isn’t feasible, there are several products out there aimed at improving traction. I frequently recommend Dr. Buzby’s toe grips for dogs. They aren’t for every dog–some resent having anything on their nails and will chew them off–but for many dogs the improvement in traction greatly improves their desire to be more mobile, which in turn helps maintain muscle mass.
Another type of traction device are these pad grips. Just like slipper socks worn in hospitals or by elderly people at home, these pads provide little friction bumps on the bottoms of the feet. Dr. Gardner suggests actually cutting them and adhering them separately to each pad so they fit better, which is an excellent suggestion and one I utilize now. There are many different brands out there; I’m linking to one here.
The other thing I recommended for Sonny was to consider an elevated food and water bowl. Arthritis in his neck was probably impacting his ability to stand with his head lowered for a significant period of time, and he would just give up. It wasn’t worth it to him to continue trying to eat under those circumstances. Again, there are a wide variety of options out there, I am just linking one as an example.
One of the most valuable tools I got out of Dr. Gardner’s webinar, however, were the journals and guides she’s created for the senior dog and cat. I’ll do a separate post on the special needs of cats in the future, as well as one on sundowning behavior in our senior pets, but I found both of these products very useful.
As someone with a senior dog who is starting to slow down, as well as show signs of some hearing loss and cognitive changes, I think having the means to track these changes will be very useful. Speaking of which, I was one of the beta testers for Suzanne Clothier’s Functional Assessment Tracking app for dogs. FAT is a unique tool for tracking a dog’s cognitive, physiological, and social well-being. It’s not just limited to senior dogs, however. The implications for its use are widespread among trainers, veterinarians, service dog handlers, boarding facilities, you name it! I highly recommend you check it out.
By the way, a week later, Sonny’s person called with an update: after instituting some changes, Sonny was back to cleaning up his meals with gusto!
The second announcement goes hand in hand with the first: I’m so pleased to be offering a digital course on Understanding Your Pet’s Labwork in conjunction with Suzanne Clothier on October 12th, at 3 pm EST.
If you’re not familiar with Suzanne, she is a highly respected dog trainer, international speaker, the bestselling author of Bones Would Rain From The Sky, and the founder of Relationship Centered Training.
I met Suzanne many years ago when I had a German Shepherd named Abbey, who’d become dog-reactive after being attacked by a neighbor’s pack of dogs that had every intention of killing her. As far as Abbey was concerned after this event, a good offense was the best defense. At the time, Suzanne was running Camp Dances with Dogs, and she agreed to have Abbey and I join as participants. I’ll never forget watching Suzanne assess my dog very accurately within a matter of minutes and determine that she wasn’t aggressive–she was terrified of being jumped again. I could scarcely believe it when Suzanne was able to select dogs out of the group that would be non-threatening to Abbey and introduce her in a controlled setting. I watched my dog relax and play for the first time in years.
My experience at Camp DWD that year had a profound impact on my life. I came away from camp not only wanting to have a different kind of relationship with my dog, but wanting to practice a different style of medicine too.
During one of my camp attendances, Suzanne invited me to be a guest speaker. I chose to talk about lab work, and why I thought it was important for pet owners to have a basic understanding of the most common test run and the implications of their results. Afterward, she encouraged me to write a book about it, and Understanding Your Pet’s Labwork was born.
It was many years in the making, however. At the time, self-publishing wasn’t possible, and I had a hard time finding a publisher who didn’t want to reduce the text to a series of bullet points. When self-publishing became widely available, it still wasn’t possible to format the charts and tables I needed. When the industry changed to accommodate such needs, it had been so long since I’d written the original material, that I had some serious editing and updating to do. In the end, I’m glad it was such a lengthy process because I’m a much better writer now than I was when I first started this project.
So I am greatly honored to be doing this webinar in conjunction with Suzanne. I’ll be hitting the highlights of the book, explaining the CBC, the chem panel, the urinalysis, and other common lab tests run. There will be a Q&A at the end, too! Not to worry if you can’t make it to the seminar live: everyone who signs up for the course will have access to the recorded material later. Win-Win for everyone!
It can be one of the most challenging things I’m asked to do as a veterinarian: Could you trim my dog or cat’s toenails?
Frequently, by the time a client is bringing a pet to us for a nail trim, it’s because no one else can do it. The expectation that somehow our staff will magically be able to perform this task after half a dozen or so other people have tried and failed is a tough one to overcome.
What many people don’t realize is can take up to one thousand good experiences to negate a single negative one. And once an animal has experienced being muscled down in order to facilitate a nail trim, the process of retraining your pet to accept this without fear or aggression may well mean that for the time being, your pet won’t be getting the nails trimmed the way you’d like them to be.
Before we discuss the re-training process on a failed nail trimming pet, let’s talk about starting out on the right paw, so to speak.
If you are fortunate enough to have adopted your pet as a young puppy or kitten, you’re in luck. You can start out teaching your young pet to accept nail trimming with lots of treats and gentle handling. I usually recommend using a human toenail trimmer at this stage, as you are both learning this process at the same time, and I find you have better control with a human nail clipper. Your pet’s nails are quite small at this juncture, and it is easier not to take too much off with the human nail clippers. As my pet gets larger (especially big dogs), I tend to switch to a scissors-type clipper. I’m not fond of the clippers that have a blade that slides forward to cut the nail, as many animals seem to act as though this pinches the nail. I prefer continuing to use human nail clippers even on adult cats, though at times cat-specific clippers may be needed, especially for ingrown nails.
Because cat’s nails are retractable, it helps to gently squeeze the paw to make the nails extend, and then you can just tip them with the clippers. Cats need access to scratching poles to shed the nail caps of old growth, and older cats no longer using poles will frequently get painful ingrown nails. Cats with extra toes frequently have similar issues with ingrown nails as they often can’t scratch with the extra toes, and even though declawing in general is not recommended, there are times when your vet may recommend declawing just the extra toes to prevent recurrent issues with growth.
Ideally, during the training process, it is helpful to have some assistance: one person to hold the puppy and give out treats while someone else trims the nails. The most important part about these sessions is that you don’t frighten the pet, or attempt to do too many nails at one time if you are meeting resistance on their part. You don’t want to teach your pet that fighting is the way out of doing something they don’t want to do, but you also don’t want nail trimming (or anything else for that matter) to turn into a major battle. I recommend starting the training within a day or two of adoption, and plan in advance to only clip one or two nails, with lots of praise and treats. Then come back again the next day and attempt a few more. Take your time. Also, choose your time wisely–a good time to attempt nail trimming is after your puppy has been playing hard and is tired.
The nails of young animals frequently have a defined “hook” at the tip that makes it easy to judge how much to take off. Just be sure to trim less than you think you can at first until both you and your pet are comfortable with the process.
I sometimes use a grinder or nail file post clipping, but not at first (one lesson at a time, build up to grinding) and not as the sole means of keeping the nails short. Used incorrectly, a grinder can overheat and burn the nail, and make your pet fearful of not only grinders but motorized clippers/shears too. The length of time it takes to grind down a long nail is longer than you realize. Best to shorten the nail first and take down the sharp edges with a grinder or file.
Just like us, animals have a nail that extends beyond the pink fleshy bit. If you’re lucky and your pet has some white nails, you can use those to judge how much to trim off the others. Cutting the nails too short WILL hurt and can make them bleed as well. This is something you want to avoid during the training and trust period so be very conservative at first. Nails grow at the rate of roughly 1/4 inch per month. You have plenty of time to go slow and teach good experiences from the start.
Short, frequent sessions with lots of praise and high value rewards (usually the kind of treat reserved for this procedure only) is the best, most reliable way to teach a puppy or kitten to have their nails cut. They now make “lick it” type cat treats that work very well for this sort of thing too. Once I teach my pets to have their nails trimmed, I usually don’t need any assistance whatsoever. I still be sure to reward them during the clipping process and again when we’re done.
Many people don’t realize that the pink part visible inside a white nail will bleed if cut, and that the blood supply can extend further than readily visible to the naked eye. We often get requests for nail trims “as short as possible” and then clients are disappointed when we don’t cut the nails back the way they would prefer. ‘Stop Quik‘ and styptic pencils used to stop bleeding if you get the nails too short can sting when applied, and this just compounds the negative experience. When in doubt, take off less.
I also prefer to have someone suspend a small dog or puppy in their arms when I’m trimming nails. This allows me to get beneath the paws and have a clear visual on how much to trim while at the same time preventing the patient from pushing off the table or floor with their feet. Again, someone is giving out treats the entire time–usually something high value like squeeze cheese or peanut butter. We have to be careful using peanut butter in a clinical setting as we must be cognizant of clients with peanut allergies, but this is certainly something you can try at home. I personally think most dogs get tired of peanut butter quickly, and it may be hard to perform a complete nail trim using it. Experiment with treats to find the one your dog really likes for this procedure. It may not be the same thing you’d use in different circumstances.
I’m sure you’ve seen or heard of people putting peanut butter on Saran wrap on their foreheads or on a hat and trimming their dogs nails without assistance while the pet licks their heads. I’m not a huge fan of this myself, as I think there is a risk putting your face that close to an animal who may or may not tolerate nail clipping. This is definitely not something I would try with an adult animal who has issues with nail trimming. I have, however, put peanut butter, squeeze cheese/cream cheese, or canned cat food on the wall at nose level while someone holds the pet in place and I clip nails.
Why does “slinging” a pet seem to work? Because in order to prevent a dog from wiggling out of your grasp, or pulling its paw away just as you go to snip, or worse, trying to bite you during the process, we typically hold the dog in a precise manner: one arm stabilizing the body, and one arm around the neck to control the head and keep the dog from biting at your hands. This is a common position for many procedures during the course of examining a dog, administering vaccinations, taking temperatures, placing a catheter, drawing blood samples, and yes, clipping nails…
Teaching your young animal to accept being held in this manner by a variety of people, including lots of high value rewards during the process is something I highly recommend. I encourage clients with new pets to practice these techniques regularly with young animals to develop trust even when it comes to performing unpleasant tasks.
But if your pet has a bad experience during nail clipping, in which several people attempt to forcibly hold your pet in place to perform the trimming, this will not only teach your pet to become highly resistant to nail clipping, but to ALL the procedures we need to perform at the vet’s office. Some animals seem more comfortable and less panicky in a sling than being body-hugged by several people. Slinging controls the body while keeping the trimmer’s hands to stay out of reach of the dog’s mouth and allows for excellent visualization of the feet. Sometimes, less is more when it comes to necessary restraint for medical procedures.
Sometimes, less is more when it comes to necessary restraint for medical procedures.
In order to take the “less is more” approach, however, and still ensure the procedure is performed (whatever that may be) as well as maintain the safety of all involved, sometimes this means muzzling your dog (or putting a specially-designed globe on your cat’s head like a spaceman’s helmet) so that only minimal restraint is necessary. Muzzling + high value food reward (such as fresh cooked chicken or tuna) + minimal restraint (someone lightly keeping the animal in one place or using a sling) can be more effective and less traumatic for EVERYONE than calling in three or four people to man-handle the pet into compliance. Most animals will fight even harder if forcibly restrained, to the point of injuring themselves and those holding them, and you’re teaching them that such procedures are bad, scary things. Animals with flat faces (such as Pugs or Persians) who can’t breathe well in the first place, justifiably panic if you attempt to keep their mouth closed during a nail trim.
Because we want to take our time with a fearful, aggressive patient that presents for a nail trim, I usually recommend the client purchase a basket muzzle and teach the dog to accept wearing it at home in a non-scary situation. Basket muzzles are designed to allow your dog to pant, drink water, and accept treats. They can wear these muzzles for a longer period of time than the traditional cloth muzzles, which can cause a dog to overheat quickly and is disastrous for a dog who can’t breathe through its nose. I also advise the client we many only get one or two nails done–our goal is to make the visit as happy as possible. I may recommend anti-anxiety medication or tranquilizers as well. I tell people up front that it is more important that we have a good nail clipping experience than to get all the nails trimmed.
I often see resistance on the part of owners to the idea of using a basket muzzle on their fearful or aggressive dogs for vet visits. I can understand their concern. We aren’t saying your dog is a bad dog, however. We’re recognizing the anxiety your pet experiences coming to the vet for medical procedures and by taking the option of biting out of the picture–as well as lowering the risk to all handlers–we’ve seen HUGE differences in the level of comfort and cooperation many of these dogs exhibit when someone tries to hold them safely. It’s the restraint for the procedure that is often the biggest problem, not the act of drawing blood or administering vaccines. Wearing the muzzle while not being forcibly held in place allows for positive reinforcement and reconditioning of a negative experience.
Unfortunately, by the time I see a pet for a nail trim, it is often because several other people have tried to manhandle the pet into compliance. Now the pet is fearful and aggressive about nail-trimming–and justifiably so. Nail trimming is often the one thing that even when we practice all the fear-reducing and safety protocols recommended, we still might not be able to do the nail trim. Remember, it can take a thousand good experiences to negate a bad one, and re-training a dog to accept nail clipping is a long, painstaking procedure that is not always successful. Some dogs need medication to manage their anxiety during the training process. Some dogs, due to the potential for human injury, can only have their nails done under general sedation, which is not practical on a regular basis.
The key to having a dog or cat that allows you to trim their nails is start early and practice regularly. You can’t wait until a dog is nine months old and then decide to take it someplace to get a supershort nail trim because the dog is scratching you when it jumps on you or damaging your flooring. Teach your dog not to jump or paw people. Teach your puppy to have its nails clipped frequently as a baby and practice on a regular basis as it grows up.
What if you’ve adopted an adult or adolescent animal who has never had its nails done and won’t allow you to do so? My recommendation is start out as though they were puppies: have a person help with holding and giving out treats while someone clips one or two nails and then STOP. Come back and do a few more the next day. Be very conservative with your trimming, especially rear nails, which are often worn shorter or black nails when you can’t judge how much to take off. You must build that level of trust in order to successfully teach nail trimming. And if your new dog gives you indications this is not something they are comfortable having you do–or you yourself are not comfortable attempting a nail trim–seek professional help. But be your dog’s advocate. Tell whoever it may be that your goal is teaching a happy nail trim–NOT forcing your dog into submission to “get the job done”. That may work once… but never again.
I train all my dogs to have their nails done as puppies. I train them to trust that whatever I do, good things will follow–including cleaning ears, opening their mouths, trading one toy for another, standing for examination, etc.
I used to have one of my dogs professionally groomed. Every time I dropped him off at the groomers, I made a point of telling them not to do his nails; I do them myself.
I forgot ONE TIME to mention this at drop off. When I came to pick my dog up, the groomer met me at the door. “We don’t normally do his nails, do we?”
“Oh no,” I said. “I take care of those.”
She made a face. “I didn’t think so. We tried, and he wasn’t very good about it, so we quit.”
I didn’t think much about it at the time. A few weeks later, when I went to trim his nails, he whined and pulled his feet away and was generally uncooperative, but I eventually got them done. I was probably sterner than I should have been, not recognizing his anxiety or why he was behaving like that but it didn’t dawn on me what was going on, in part because no one was holding him for the procedure. I didn’t think too much about it until a month later when he had to be sedated for a biopsy. When the assistant put her arms around him in the typical position to restrain for an injection–similar to the position when someone holds for a nail trim–he screamed like he was being boiled alive in oil. If ever a dog had a PTSD flashback, that was what it would look like. His eyes dilated to black holes and his gums went white. He clearly didn’t recognize me or anyone working with him. We couldn’t calm him down until we let him go. It was a horrible thing to witness. Worse to know that I’d somehow allowed this to happen to him without even realizing it.
It was only then I connected the dots. That “attempt” to clip his nails had to have been a bad one. I had to retrain him from the ground up to accept being held for various procedures and the only reason it worked is because the groundwork for trust had already been laid in the first place. We just had to uncover it again, slowly, with lots of love and patience. As it was, the rest of his life, I had to be present for any sort of procedure that required his being held. He wouldn’t let anyone else do it.
If the trust isn’t there to start, then you may never be able to undo a bad nail trimming experience. For some reason, this seems to apply more to nail trimming than almost any other medical procedure we perform on animals. Perhaps it is because animals are instinctively foot-protective. Perhaps it is because a broken nail is very painful. I think a large part of it is because many people do not lay the proper groundwork for this procedure and then don’t understand what went wrong when your pet won’t allow it. You may not have been the one to violate your pet’s trust in the first place. But trust is the foundation for successful nail clipping.
I don’t know about you, but I’m guilty of not cleaning my pets’ bowls as frequently as I should. I recently read an article in the Your Dog Newsletter from Tufts University that said pet dishes contained the ninth highest levels of bacteria in our homes–even higher in some cases than toilet bowls.
Perhaps for many of us, this doesn’t seem to be an issue. Our pets are healthy, and we ourselves show no signs of illness. But many households contain immunocompromised individuals (at least 2.7 per 100 people). Pregnant women and children under five years of age are also at higher risk for developing serious illness when exposed to certain food-borne bacteria. Hardly a day goes by when we don’t hear of a pet food recall due to salmonella or listeria. Good pet food handling habits become even more important if you feed a raw diet to your pets, as the risks of exposure to such bacteria is even higher.
A study in the Plos One Journal examined the habits of pet owners regarding the storage and distribution of food, and discovered most people did not wash their hands before handling their pet’s food. One in five participants reported washing their pet’s dishes only once a week. Many said they didn’t wash their pet’s bowls more than once every three months–if ever.
As I said before, I’m guilty of practicing less than perfect pet food hygiene, even though there are some parts of the FDA guidelines I know and recommend.
But after doing a little research to write this post, I realize I need to do a better job. The FDA guidelines are pretty basic:
Wash your hands before handling your pet’s food (at least 20 seconds with soap and water). If you sing “Happy Birthday” or recite the opening sequence of the original Star Trek series (“Space: the Final Frontier. These are the voyages of the Starship Enterprise… etc), that is the perfect length of time to wash your hands.
Use a designated utensil for scooping food (not your pet’s bowl) and wash both the scooping utensil and the bowl after EACH USE.
Throw out old, spoiled food in a manner than your pet cannot access it. Bag it and place in a trash can either outside or with a locking lid.
Food storage is also critical.
Promptly refrigerate or throw out unused or leftover canned and pouched pet food. Tightly cover refrigerated pet food with the correct-sized lid Make sure your refrigerator temperature is set to 40 F or below.
Store dry pet food in a cool and dry place. The temperature should be less than 80 F. Excess heat or moisture can cause spoilage. Keeping your pets’s food in the garage is NOT a good idea.
Store dry pet food in its original bag and keep the top of the bag tightly folded down with clips or tape.
Keep pet food in a secure location to prevent your pet from eating an entire supply at once. A locking trash can is a good option.
One of the most common mistakes I see people make is purchasing food and dumping it into plastic bins for ease of storage
Lamb based dog food in particular can mold in as little as a few weeks, so if you feed lamb, you probably should buy smaller bags to use it up more quickly. One of the most common mistakes I see people make is purchasing food and dumping it into plastic bins for ease of storage (and prevent mice from getting into it). The problem with this is that you never completely remove all the crumbs from your bin before dumping the next bag on top, increasing the risk of developing mold. It is best to keep your pet’s food in the original bag and roll the top down tightly. You can still put it in your storage bin–just keep it in the original bag.
I’ve also had clients who store their pet’s food in the garage, and high, humid temperatures in the summer can destroy the value of the food as well as promote spoilage.
So bottom line, wash your hands before and after handling your pet’s food, be sure to wash bowls and utensils daily. Take steps to store your pet’s food properly. These simple steps can help keep you and your pet safer and a lot healthier.
Last week we addressed the fact that allergies in pets tends to fall into two broad categories: seasonal and all-year-round. In the previous post Help! My Dog is Itchy! Part 1: Fleas and Food, we discussed two types of allergies that were examples of each category. One could argue that in some areas, fleas would be considered a year-round problem as well, but for the purposes of our discussion, we’ll leave it as previously listed.
Even though allergies tend to fall into those overall categories, we also know it is possible to be allergic to multiple things, and there can be a degree of overlap when trying get to the bottom of an allergy. So instead of discussing this topic in terms of seasonal vs all-year-round, I chose to break up the discussion along the lines of how someone would work an allergic case up rather than strict categories.
ALWAYS rule out ectoparasites first. Fleas, ticks, lice, mites… you can’t assume that your flea product is working. You might have forgotten to apply it, or accidentally washed it off, or there is resistance developing to the product you’ve used for years, or it simply isn’t that good in the first place. Most of time, it’s necessary to use an actual flea/tick medication to have effective control. Essential oils, diatomaceous earth, borox powder, garlic and brewers yeast all carry potential risks with their use and are unlikely to be effective. And unlike fleas, lice, or ticks, mange mites are not visible to the naked eye and usually must be diagnosed with a skin scraping.
Secondary yeast infections are also common, which is one of the reasons the itchy dog smells bad. Unlike bacteria, we don’t see yeast being resistant to medication–but damaged skin is a good environment for yeast to grow, and recurrent yeast infections are common in allergic pets. Sometimes antifungal medications or shampoos are part of the primary treatment as well. If your pet isn’t responding to treatment with some of the newer allergy treatments, it may be because of concurrent skin infections.
Keep in mind too, that it takes time for new skin/hair cell turnover to take place, and we have to give allergy management enough time to see if it will make a difference. Sometimes the best we can do it calm things down to a flare once or twice a year rather than all year long.
We also talked extensively about food allergies in the last post, and why your vet may choose to rule out a such an allergy by recommending a hypoallergenic food trial before attempting to rule out environmental causes of a year-round allergy.
That’s because it can be challenging to determine what the underlying allergen may be.
There are a couple of ways you can try to figure out what may be causing your dog to itch. The gold standard in veterinary dermatology is to do the skin patch test, where the fur is clipped off one side of your dog and the dermatologist injects tiny amounts of the most common allergens under the skin. Over time, if your dog is allergic to say, flea saliva or ragweed, a wheal will develop around the site of the injected material. The bigger the wheal, the stronger the allergy.
An alternative method is to draw a blood sample and have it sent out for serum allergy testing. The lab is looking for specific IgE antibodies to indicate an allergy to a specific agent. Most labs have region-specific panels, as there is no reason to test for Kentucky Bluegrass if it is not common in your area. Like the skin testing, these tests also include common allergens such as house dust, mold, and flea saliva.
It is also possible some of these allergen panels may include food. I don’t usually recommend doing a serum food allergy panel over an actual food trial. The hypoallergenic food trial seems to be more accurate to me.
Let’s say your dog’s testing comes back with really high titers to house dust, fleas, and ragweed. It’s possible that by controlling the dust in your house (which can be extremely difficult) with HEPA filters and cleaning, maintaining good flea control, and proactively managing the allergies during the ragweed season, your dog’s allergies may not be that bad. It’s also possible that your dog is so sensitive to house dust, that your vet may recommend desensitization allergy shots, in which a tiny amount of the allergen is given by injection to deaden the body’s reaction to it, and then in increasing strength over time. The vials of injectible “allergy shots” are custom made around your dog’s allergies, and will change in strength as your dog becomes less sensitive to the triggering allergen. Giving these injections is something you as an owner must learn how to do, as the process often takes at least a year to see signs of improvement and frequently has to be maintained indefinitely.
I had severe allergies as a child to many, many different kinds of pollen, grass, and weeds. I took allergy shots for seven years, and as an adult only have issues when we put up hay for the horses. This kind of success isn’t guaranteed by any means, but it’s an example of how desensitization shots work.
Sometimes the tests come back indicating your dog is allergic to a whole slew of things. I tested one dog once that was positive for over 24 items. There are only so many allergens you can put into a serum for injection–usually 6-12–so in this case, we picked the 12 allergens that were the most severe to control to create the allergy shots.
Unfortunately, the term “allergy shot” is also used by some people to describe moderate to long-acting steroid shots vets sometimes give to animals to break an itch-scratch cycle. These steroid injections, while sometimes medically necessary, are not an appropriate means of controlling allergies long-term, nor is administering steroid tablets. Steroids have their place in vet medicine, but they also have a lot of negative side effects.
Why do we use them, then?
Well, dogs don’t have the same histamine receptors as people do, so antihistamines don’t always work in dogs. We try them, however, because if they do help, they are an inexpensive means of helping the itchy dog with few side effects. However, once your dog reaches a certain threshold of itchiness, even those dogs that benefit from antihistamines can have breakthrough itching. Which is why prednisone and other steroids have been used to stop the itch. Sometimes clients–or veterinarians themselves–don’t want to put the time, money, or effort into controlling the allergies in a better way, and steroids wind up being an effective, but risky shortcut to long-term management.
Up until recently, veterinarians really didn’t have many options to treat allergic animals if the underlying allergen couldn’t be identified or avoided. You might know your dog is allergic to pollen, but that doesn’t exactly help you when everything outside is covered with green and yellow dust.
We also used to think that the respiratory system was the biggest source of exposure–that is to say, we thought environmental allergies were an inhalant problem. We know now in animals, the problem is largely due to absorption through the skin, and this is why the cycle of allergies> damaged skin> immune effects > allergies is a vicious circle.
Fortunately, we have more choices for managing the itchy, allergic dog now.
One of the first products that was an alternative to steroids and antihistamines in dogs was Atopica. The clinical name for dogs with skin allergies is atopic dermatitis. Atopica is a cyclosporine based medication that inhibits the function of the T-lymphocytes, so there are conditions in which it is contraindicated (such as dogs with cancer, or pregnant dogs). It comes in a capsule form that is typically given daily all year round or during the allergy season affecting your pet.
More recently, we’ve seen the arrival of Apoquel tablets and Cytopoint injections which both work on cytokines which interact with allergens (though in different ways), to prevent the allergen from triggering a reaction in the body. Apoquel, like Atopica, is given daily, or seasonally. Cytopoint injections last anywhere from 4-8 weeks depending on the dog and the number of allergens involved. I’ve seen good success–as well as side effects–with all three of these products. There is also individual differences in response to treatment, so your vet may have to try different things to find the best treatment for your dog.
Remember when we said itching leads to skin damage and allergies lead to chronic skin changes? Your dog may not have a food allergy, but could still benefit from being on a prescription skin support diet to improve the health of its skin from the inside out. There are also shampoos, mousses, and fatty acid supplements designed to improve skin health from the inside out. These topical products are often used in support of the bigger agents in our arsenal, such as Cytopoint or Atopica. Improving the health of the skin improves the barrier of the skin to allergens.
If you read the previous post (linked above) you’ll know the reason I posted about the management of itchy dogs in the first place is because of someone online asking for help with her dog’s chronic ear infections. I find that chronic, severe, ear infections frequently have an underlying allergy as the problem (even if it is only one ear). This is even more frustrating because agents like Cytopoint and Apoquel, while often stopping the itch, may not help with ear problems.
As frustrating as it may be to have an itchy dog, there is hope with the newer treatments available, so talk to your vet to lay out a logical plan of action. Just understand that even with combination therapies, it may still be difficult to completely control the allergies.
The other night, I broke one of my cardinal rules and got involved in a discussion about pet health care on Facebook.
Someone posted about their dog’s chronic ear problems, and asked for help, particularly from the veterinary community.
I find this sort of situation frustrating. Obviously, this person has struggled to find an answer for her dog’s problems. Having been to several vets without success, she turned to social media. The amount of incorrect and potentially dangerous information I see on these kinds of posts makes it hard for me to resist weighing in, but most of the time, I can fight the urge.
But this time, I tried to help, and very quickly, the poster became defensive at both my line of questioning and recommendations.
“We’ve already switched her food several times. We’ve already tried this product. That drug didn’t work.”
I don’t blame the poster for feeling as though my questions were unhelpful or that we were treading down the same road previously traveled without success. It made me realize two things: social media really isn’t the best place to disseminate information and I needed to write a blog post about the itchy dog.
When you are first trying to work up any sort of medical problem, your veterinarian begins with the signalment and history.
Signalment means: what kind of dog, how old is it, has it been spayed or neutered, and so on. Signalment is important because certain kinds of dogs are prone to certain kinds of problems. Also, some issues start at a certain point in life, and are unlikely if the patient isn’t in that age bracket. Other problems may not exist at all in the spayed or neutered pet–or may be more likely in the spayed or neutered pet. Signalment gives you a starting point for determining what’s going on.
History is equally as important, especially in working up the itchy dog. We need to know when the problem started, does it respond to treatment, does it relapse when the course of medication is completed, does there seem to be a pattern to when it occurs? Has there been a diet change, move to a new environment, new stressors in the house, are you using flea control, are there other pets in the house, and so on.
If I see an itchy dog in mid-summer in my region (Mid-Atlantic U.S.), and there is clear evidence of chewing at the tail head, even if the client tells me they have been using flea control, I’m going to look for fleas first until proven otherwise. Why? Because the flea populations explode at this time of year, many people are forgetful about using products until a problem gets out of control, and we can see resistance to medications over time. Or the client may not be treating all the animals because only the dog goes outside.
Did you know that cat fleas cause more allergic skin reactions on dogs than dog fleas do? Also, some of the worst flea infestations I’ve ever seen–to the point of needing blood transfusions–have been in 100% indoor cats because their people didn’t believe indoor pets could get fleas, and they were trapped in the house with them as the numbers rose. So make sure you discuss with your vet what your safe flea and tick control options are, and at the very least, run a flea comb through your cats the first of every month to make sure they don’t have a problem before it gets out of hand.
“Flea dirt” pulled off a combed pet that was supposed to be on flea control
But in other parts of the U.S., fleas aren’t even a issue! (Where are these parts and can I move there?) It’s true, some places out West, due to altitude, don’t have to deal with fleas.
Regardless, when presented with an itchy pet, the first thing I do is rule out ectoparasites. This means parasites that live on the outside of the body, such as fleas, skin mites, and lice. Many of these parasites can affect other members of the household, so history becomes important there, too. Are any of the other members of the house (including people) itchy as well? If so, the cause is more likely to be something contagious or that they are all exposed to, which puts an allergy to a specific thing lower on the list. Allergies aren’t contagious!
Ruling out ectoparasites isn’t always easy. Sometimes you find evidence of them by combing or performing skin scrapes. But just because you can’t find any signs of fleas or see mites under the microscope with a skin scraping doesn’t mean they aren’t there. Sadly, I’ve seen people spend thousands on working up their pet’s skin problems when a good dose of flea and tick control was all that was needed. Some of the newer oral medications also kill lice, as well as demodex and sarcoptes mange mites, even though they aren’t labeled for it. So don’t balk when your vet recommends a good flea product as part of the work up. It may save you money and heartache in the end.
But suppose your dog has been getting good ectoparasite control and is still itchy. Where your pet scratches and licks can be very important in narrowing down the problem. Does your dog have ear problems as well? Are there also digestion issues? If so, food may be a factor. Cats tend to demonstrate their allergic problems differently from dogs, so we’ll do a post about them in the future.
Generally speaking, working up allergic skin problems falls into two broad categories: seasonal or all year round. Seasonal allergies typically begin between 1-4 years of age and are worst during the spring and fall. Unfortunately, with age, they can start sooner and last longer until they are present almost year round, but initially there is a strong seasonal pattern.
“All year round” allergies tend to fall into two broad categories: food and environmental. Most vets recommend starting with a hypoallergenic food trial to rule out a food allergy because it can be easier to get definitive results and improvement than trying to manage environmental allergies. This is where I often run into resistance with clients. They don’t want to change their food. The guy who works at the pet store told them this was the best food to feed. They’ve already tried switching diets, freeze-dried food, avoiding chicken, etc.
Many years ago, there were not any commercial diets for hypoallergenic food trials for dogs. When a veterinary dermatologist wanted to put your dog on a food trial, they told you to cook lamb and rice, not because there was anything special about lamb and rice but because since they weren’t common ingredients in the kibble of the day, your dog was unlikely to already be allergic to it. This was called a novel protein diet. If it worked, it was because your dog had never eaten lamb before. There is nothing magical about a lamb and rice diet.
There is nothing magical about a lamb and rice diet.
When the dog food companies realized “lamb and rice is good for skin”, they began producing it. Many people fed it to their dogs. So vet dermatologists, looking for another novel protein diet for food trials, told their clients to feed fish and sweet potato… see where I’m going with this? Now there are so many specialty foods with so many specialty ingredients, finding a novel protein/novel carbohydrate diet can be challenging.
The grain-free pet food craze grew, in part, out of a culture where more and more people were eliminating glutens and grains from their lives, and also because wheat is a common food allergen in dogs, so by going grain-free, many dogs showed improvement in their allergies. At one time, I myself recommended grain-free diets to clients who couldn’t afford the pricey hypoallergenic foods. The dog food companies jumped on the bandwagon, sensing a new market and a clientele willing to pay higher prices for foods perceived to be healthier. The last time I checked, 90% of the kibble on the “Ten Best Dog Foods of the Year” kinds of lists were grain-free.
Then veterinarians began noticing a huge jump in an uncommon heart condition of middle-aged dogs known as cardiomyopathy. Dogs as young as 4 months of age as well as breeds not known for developing this disease were getting it. Breed clubs began working with vets to compile information and a pattern emerged. Of the 500+ cases examined in one study, 93% of the pets were on a grain-free diet. Now, correlation is not causation (meaning just because you see a pattern, doesn’t mean it’s the cause of the problem) but it was enough for the FDA to recommend not feeding grain free foods to your pets. Cardiologists, nutritionists, and dermatologists all speaking at the last veterinary conference I attended said the same.
The weird thing is that these foods have all the right ingredients in them in all the right amounts, but there is something about the pea/legume or potato-based diets that are preventing the heart-protective amino acids such as taurine and carnitine from being bioavailable to your pet (this is important in cats too).
So what do you do if you’re trying to figure out if your dog has a food allergy? The easiest way is to talk to your veterinarian about doing a true hypoallergenic food trial. Not playing dog food roulette by changing brands and flavors every few weeks. Not going grain free. Not even going “limited ingredient.” There are still prescription novel protein diets out there, but their effectiveness has decreased with the advent of so many dog foods containing a whole smorgasbord of ingredients. Also, we’re seeing now that if your dog is allergic to chicken, it may be allergic to duck as well. Same with beef and bison or venison.
A true hypoallergenic food uses hydrolyzed protein instead of a novel one. In order to trigger an allergenic reaction, the protein must be of a certain molecular weight. By hydrolyzing the protein (using a chemical process to make it smaller on a molecular level) the source used doesn’t matter. A dog that’s allergic to chicken can’t react to hydrolyzed chicken.
Depending on the diet chosen, your typical food trial runs 4 to 12 weeks. NO OTHER FOOD OR TREATS but the hypoallergenic food are allowed during the trial (the exception being once-a-month heartworm or flea and tick meds). What we’re looking for is a 50% improvement in that time: less itching, less inflammation in the ears, less stomach or digestive issues. If you are seeing some improvement by 4 weeks, it’s usually recommended to extend the trial a bit longer to see if it is making a real difference. One of the problems of working up allergies is your pet can be allergic to multiple things. If you are seeing no improvement by the end of the food trial, then you can probably take food off the list and move on to looking for another source of the allergies.
Ears often take the longest time to show improvement, but in my opinion are the part of the body most frequently affected by food allergies. I’ve seen some dogs do great on a hypoallergenic diet only to relapse during spring and fall because of seasonal allergies on top of the food issues. Allergies are cumulative, meaning they add up, so if you know your pet has food or seasonal issues and then you get a flea problem on top of that, expect the skin problems and itching to explode!
You can try a novel protein diet instead. It may take longer to see results if you’re feeding rabbit and green peas than a hydrolyzed protein but it’s still valid to consider as a trial. Just be sure to get a prescription version (that has extra taurine and carnitine in it over the boutique versions), and understand that not only does cross-reactivity occur with certain proteins, but it is possible to develop an allergy over time to the new protein as well (which can’t happen with the hydrolyzed foods).
You can also cook for your dog. As I said before, this is what veterinarians used to recommend before there were prescription diets. The challenge here is finding a protein and carbohydrate source that you can get on a regular basis for the length of the trial that your dog hasn’t already eaten (because you typically aren’t allergic to foods you’ve never been exposed to before) and getting the vitamin and mineral balances right. I recommend using the website balanceit.com for creating a home cooked diet for your dog. You can plug in the protein and carb source you wish to use (for example, venison and brown rice) and they will help you determine proportions as well as create a vitamin and mineral combination to meet your home cooked diet’s needs. The new site even allows for combinations of additional oils and vegetables too. One of the advantages of cooking for your dog is this method can also eliminate less common food allergens, such as allergies to preservatives and grain mites. I had one client whose dog’s severe food allergies was controlled by freezing the food first, as her dog had a grain mite allergy. But that’s not the typical case!
The key here is that it’s crucial to conduct a true hypoallergenic food trial so you can rule food in or out as a player in your dog’s allergies. You may think you have, but unless you’ve conducted a trial with a prescription diet, this may not be the case.
If your dog turns out to have a food allergy, clap your hands and jump up and down with joy because this is truly one of the easiest types of allergies to manage and see real improvement! I believe every dollar spent on food will save you in medical bills and you’ll have a happier, healthier pet as a result.
We’ll talk about environmental allergies, how to identify them and manage them, in another post.
Most people have heard of the rabies virus. It’s one of the few vaccinations required by law here in the U.S. for dogs and cats, with some areas requiring you to purchase licenses as well to document your pet’s up to date status.
Some people know that rabies is only transmitted by mammals, which are fur-bearing creatures that also produce milk for their young. ANY mammal can develop and spread rabies, but in reality, there are four main species here in the U.S. we consider at high risk for spreading rabies: foxes, skunks, raccoons, and bats. Worldwide, dogs are the most common source of rabies (which is something you need to consider when traveling to countries where rabies is present), but dogs typically only make up 5% of the rabies cases in the U.S. In the Americas, bats are the most common source of the infection. This is due in part to vaccination protocols for pets.
I’ll never forget the time I saw a documentary about the number of urban foxes living in London, and how some people fed them like squirrels. Much as I love foxes, I was aghast at this notion until I remembered rabies isn’t present in the United Kingdom. That’s one of the reasons it is so difficult to get a dog or cat into certain countries (or Hawaii, for that matter). They don’t have rabies in these places (often islands or continents isolated by water) and they don’t want it there.
“What does rabies do to you anyway?”
That was the question a client asked when I plead with her at the VERY LEAST, please vaccinate the feral tom cat she allowed to sleep on her toddler’s bed every night.
Sometimes I think that vaccinations are the victims of their own success. Because we’ve eradicated or limited the damage of so many serious diseases due to vaccination, there are many people out there who believe the vaccination is more harmful than the disease itself, or who don’t realize just how important vaccination is to public safety.
Instead of yelling at my clueless client, I explained that rabies is a virus that causes inflammation of the brain. There is no way to diagnose it in the living person before symptoms appear, and it is almost always fatal once symptoms do appear. While most people assume the only way to get rabies is by being bitten by a rabid animal, saliva from an infected animal can transmit the virus if the spit comes into contact with broken skin, or in the eyes, nose, and mouth. The virus is also present in the spinal fluid of affected animals, which is another reason why you must be very careful how you handle an animal you suspect might have rabies.
Once the virus gets into the nervous system, it travels very slowly to the brain. It typically takes anywhere from one to three months for someone who has contracted the disease to begin showing symptoms, though the closer the area of exposure is to the brain (say the eye versus being bitten on the foot), the shorter the time course of the disease. The symptoms vary so much, it can be hard to identify them at first. Humans may experience nausea, uncontrollable movements, an inability to swallow, confusion, and coma. Photophobia (an avoidance of bright light) can also be a symptom. Dogs and cats often show behavioral changes, including aggression and uncontrollable seizures. They frequently salivate heavily and avoid water, not because they are afraid of water (hydrophobia) but because it hurts so much to swallow, there is an avoidance factor at work. In the “dumb” form (the non-aggressive kind) of rabies, wild animals will often act tame, or appear drunk and disoriented. They can circle aimlessly or appear partially paralyzed. Self-mutilation is not uncommon.
As of 2016, only fourteen people have survived rabies once they developed clinical signs.
This is why it is critical to start post-exposure vaccination and immunotherapy as soon as any potential exposure occurs, as this is very effective in preventing the development of the disease.
Wait a minute, I can hear you say. You said it can take months for the symptoms to appear, but we only quarantine a suspected rabid dog or cat for 14 days. More on the reason behind that when we discuss what to do in the face of a possible exposure.
Vaccination is the hero in the rabies prevention story. Worldwide vaccination of humans has decreased the risk of mortality in those regions where rabies is rampant. Here in the U.S., people in high-risk professions (such as veterinarians, support staff, and people who work with wildlife) get vaccinated to help protect them in the face of exposure. Because it is not unusual for people who get vaccinated for rabies to develop reactions to this particular vaccine, instead of getting booster shots, people who have been protectively vaccinated against rabies undergo titer testing every couple of years to make sure they have a protective level of antibodies in case of exposure.
Having a protective titer doesn’t mean you don’t get boosted if you do get exposed, however! Let’s walk through the different scenarios.
I mentioned above that when a dog, cat, or ferret bites someone, it is only quarantined for 14 days in most parts of the U.S. That is because we know if an animal bites you because it has rabies (and not because it was scared or aggressive), it will die from the disease within that time frame. So, if a dog or cat bites someone, regardless of its rabies vaccination status, the health department will insist on a quarantine period. Because rabies vaccination is so effective, however, the restrictiveness of the quarantine for a pet is likely to be less severe than if the rabies status of the animal is unknown (as in a feral animal).
That is not to say that animals vaccinated for rabies are always completely protected in the face of exposure. There can be issues with a vaccine lot number, or improper handling of the vaccine itself (such as vaccines that should be refrigerated arriving with the ice packs melted, or a power outage resulting in the storage unit getting too hot). The rabies vaccination may also fail to take effect if the animal is ill at the time of vaccination. I have to vaccinate a puppy by 16 weeks of age because it’s required by law in my area, but if that puppy has severe demodectic mange (which could indicate a compromised immune system), I’m going to recommend an additional rabies booster once the medical condition is resolved. These are just some of the reasons that a companion animal might need to be quarantined despite proof of vaccination.
If a wild animal bites someone, and can be caught, it will be humanely destroyed and have its head removed because examination of brain matter is the only way to test for rabies at this time. Because it is imperative that rabies prophylaxis treatment begins right away when humans are bitten, there are no exceptions if this occurs. And because wolf-hybrids are considered wild species (and rabies vaccines were not tested or approved for use in those species), there is no quarantine period if a wolf-hybrid bites someone. It is automatically euthanized. Many of the people who boast of having a wolf-hybrid have no such thing. In reality they have a mix of one of the Arctic Circle breeds, such as a Siberian Husky or Alaskan Malamute. Please, please, please do DNA testing on your dog before you go around telling people it is a wolf-hybrid.
In order to be tested for rabies (and in order for you to avoid undergoing the expensive and uncomfortable post-exposure treatment), the brain of the affected animal must be examined. This means it is critical that if you must shoot a wild animal attacking you or your pets, you avoid shooting it in the head if at all possible. Not only will it make it nearly impossible to test for rabies if the head is destroyed, but you could well have explosively scattered bits of rabies-infected material all over everyone nearby. It is also critical that testing be done as soon as possible. Animals that have begun to decay in a hot environment may not have viable brain matter to test. DO NOT FREEZE ANY CARCASSES. Freezing will also destroy the rabies virus and prevent identification. Ideally, the remains should be refrigerated and taken either directly to the nearest state laboratory or to a professional equipped to safely remove the head for shipment. Remember, the virus is in the central spinal fluid as well as in the saliva.
The real issue is when you are dealing with the potential exposure to you or your pet by a rabid animal such as a racoon or bat. Remember the long incubation period? So, while we know that if an animal bites you because is it rabid, it will die in a specific period of time due to the disease. It will take you or your pet weeks to months to show signs of illness if you are exposed.
There are a couple of different scenarios to look at here. Let’s take the animal contact ones first before examining the human contact situations.
First: Your vaccinated pet comes into contact with a wild animal, but you are unable to present it for rabies testing because it ran off. Your pet’s rabies vaccine is up to date. The health department will probably recommend boosting the rabies vaccination right away and no quarantine period, depending on the degree of contact and if there was any human involvement as well. Your pet should be examined for wounds by your veterinarian.
Second: Your up to date, vaccinated pet fights with a wild animal which is then killed or trapped by either your pet or you. If the animal is deceased, you should (wearing gloves and a mask) bag the dead animal and contact the health department. If the animal is still alive, leave it completely alone and contact the health department. If it is after hours and you cannot get someone out to you, contain the wild animal as best as possible if doing so will not risk further exposure to you or your pet. Try to get animal control out as soon as possible so the wild animal can be safely euthanized and tested.
If the wild animal doesn’t have rabies, all is well. If the animal DOES have rabies, then the health department will institute some kind of quarantine period for at least 45 days. This is because no vaccine is 100% effective (as we discussed earlier) and because on average, an animal infected by rabies will develop clinical signs by this time. However, because rabies vaccination is considered very effective, usually the quarantine procedure will not be as restrictive (must remain confined on the property, such as in a pen or a horse stall, only one person designated to care for the animal, etc.) as it would be if the pet were not up to date on vaccination. The rabies vaccine may be boosted at the beginning of the quarantine period or the end, depending on the locality and regulations.
Third: The exposed pet in question is NOT up to date, or worse, has never been vaccinated at all. Now the health department will institute very strict quarantine protocols. Most departments will require the pet to be confined in a pen inside another pen, with no possibility of human contact whatsoever for six months. This is very upsetting to a well-socialized pet accustomed to being part of the family, but it is devastating to a young animal that hasn’t had much human contact in the first place.
I will never forget the tragedy of having to euthanize an entire litter of seven-week-old Labrador Retriever puppies. We’d just seen them the week before for their first distemper/parvo vaccines. A confirmed rabid skunk got in the pen with them, and their breeder made the heartbreaking decision to euthanize them rather than attempt to quarantine them under the strict guidelines. They realized at the end of the six-month period that the puppies would be impossible to rehome, as they would have been more like wild animals than dogs raised in a loving environment.
Remember what I said about bats being the most common source of rabies exposure in the U.S.? Do not assume that that your 100% indoor pet doesn’t need rabies vaccination. It does because it’s the law. It does because if your pet bites a visitor (or in one case I know, the person rescuing it during a house fire), the health department will get involved. And lastly, I know of three clients who have had rabid bats get into their homes. Keep your pets legal and safe!
The health department must be merciless when it comes to protecting the public from a possible rabies exposure. It has to be. I recall many years ago when someone exposed over forty people at a church social to rabies by bringing a baby raccoon to the event. The rabies vector species can be carrying the virus at birth, and raccoons can have rabies without showing any clinical signs. Every person exposed at that event had to undergo the expensive and uncomfortable post-exposure series of shots.
The fact remains that over 70% of rabies cases in the U.S. are as the result of bat bites or scratches. Many times, the victim has no recollection of when the exposure occurred. The other cases are usually due to contact with wildlife, and after that, contact with a rabid companion species, such as a dog or cat. Because many communities don’t require licenses for them, cats are more likely to not be current on their rabies vaccinations. Because outdoor cats hunt, hang around barns, and their feeding stations can attract wildlife, cats often come into contact with the vector species. As a professional, I can tell you it is frustrating to be presented with a sick pet and not be able to immediately take rabies off the list of possible problems.
Livestock are also at risk of exposure to rabies-vector species, and you should talk to your veterinarian about vaccination.
What happens when there is human exposure, such as the example of the church picnic?
The protocols vary on an individual basis, depending on how much contact you had with the affected animal, and whether or not it can be proven the animal was indeed rabid. You must work closely with the health department and your doctor to determine what is best for you.
If you have never had the pre-exposure rabies vaccination series, recommended for anyone working in a high-risk profession (veterinary medicine, wildlife management, etc.), then if it is determined you need post-exposure treatment, you will be given a large dose of immunoglobulins first. This is to give you an immediate passive transfer of antibodies against the virus. It’s called passive transfer because these are not antibodies you created yourself. Think of passive transfer like a large patch on a deep, bleeding wound. It will stop the bleeding long enough for you to get to the hospital, but you’re still going to need stitches to close the wound.
The immunoglobulin therapy (large volume given by injection in a large muscle, probably the one you sit on) is then followed by a series of rabies vaccinations. Currently, the protocol requires a series of five boosters given over a period of many weeks. This stimulates your own immune system to create an active antibody response to the threat. This is necessary because passively transferred antibodies won’t hang around for the months and months needed to completely protect you if the virus gets into your nervous system.
What happens if a previously vaccinated person gets exposed to a rabid animal? That happened to me. A dog came in on emergency having seizures. It was a stray dog the family had been feeding for about a month. The differential list of possible problems included organophosphate poisoning, mushroom toxicity, epilepsy, canine distemper, and rabies. The patient’s lab work was unremarkable, and he appeared to respond to strong anticonvulsants as the seizures stopped and his behavior was completely normal.
Twenty-four hours later, he died.
We insisted on rabies testing, much to the resistance of everyone involved. Rabies wasn’t considered very high on the rule-out list, and the dog hadn’t bitten anyone. But we persisted, and the dog came back positive for rabies.
When a pre-vaccinated person is exposed to rabies, the first thing they do is they check your rabies titer. If your titer is below the recommended levels for protection, you are treated like an unvaccinated person and must get the immunoglobulin therapy as well as the five booster shots. If your titer is good, they skip the immunoglobulin therapy and give you only two boosters.
It doesn’t matter if the titer is considered “good.” Rabies is almost always fatal, so booster shots are ALWAYS given to the pre-vaccinated person. The titer determines how many and if the immunoglobulin is needed or not.
I was fortunate enough to have a strong titer, and only needed two boosters, which is good because I developed hives from head to foot after the second booster and was told I could not take anything systematically to treat them—no Benadryl, no steroids. Anything I took to minimize the symptoms might limit the effectiveness my immune response to the vaccination. The only thing I was allowed to use was a little over the counter topical cortisone cream.
As I mentioned before, because reaction to rabies vaccination in humans is common, instead of getting regular rabies vaccinations like your dog or cat, people get their titers checked every couple of years and only get boosted if the titer is low. I’m lucky in that my titer has been high ever since, so I have not needed additional boosters, but that could change if I am exposed to another rabid animal. At the same time, I consider myself lucky I live in a time when vaccinations can protect both myself and our pets against such a devastating disease.
Don’t take the risk of having an unvaccinated pet. While there may be medical exceptions at times, vaccinating your pet for rabies is the safest, smartest thing you can do.
