Wound Repair, Take Two. How To Treat Your Dog Fight Wounds.

Don't you agree that her wound doesn't look too bad?
That's a very common assumption, and unfortunately, its often wrong.

This is Whiskey, a rather rambunctious three year old spayed girl who is more likely to greet you with a loud, ferocious bark and fierce lunge forward to remind you to stand down, turn around, and visit someone else, than a offer a wag and a smile.

As fate will have it, if you yell angrily at enough other dogs one of them is going to meet your nasty bark with an arcade of teeth and leave you with a wound to your face and a subsequent needed visit to the vet.

Whiskey came in on a Sunday for a bite wound that she had received on Friday. Her family had thought that it was just a small scratch, and no one wanted to incur a vet bill, especially in light of Whiskey's poor attitude.

On Sunday's visit it was decided to try to take a conservative approach. Whiskey was acting normally, eating, drinking, breathing, ambulating were all normal, and finances were tight. We flushed the wound (muzzle necessary), and applied 4 staples to keep the edges together.  She was in and out of our door with the minimum treatment plan available. The cost for this visit, $75, (an exam and 4 staples).

The next day Whiskey's mom called to say that she was in need of some pain medication. She came by to pick up a prescription for an NSAID.

On Tuesday afternoon the staples were missing and the wound wasn't smelling so good.

Tuesday night we treated Whiskey's wound more aggressively. We clipped the wound, applied a numbing agent and tried to suture it closed. We could have sedated her but her wound was not deep and did not require a drain. It was also very difficult to suture so close to her eye so we decided instead to staple it closed (again). This time Whiskey went home with an e-collar to protect her face and prohibit her from rubbing or pawing at the wound.

Lidocaine jel applied to the wound to provide a topical anesthetic.

Here is a video of us exploring Whiskey's wound. Any wound that is deep or dirty should be explored under general anesthesia. General anesthesia also allows us to explore and identify pockets, embedded debris, compromised structures and remove damaged tissue to speed up healing. In some cases an old wound needs to be cultured to identify which bacteria is residing in it and help identify the best antibiotic to treat it.

After clipping the wound it was closed. We had a long discussion about how to best do this;

1. Allow it to close on its own. In some cases this is best. These include wounds that have already got a good bed of granulation tissue. Or wounds that are so large we cannot close them.

2. Close it with glue, sutures, a full closure of the wound. This is the fastest way to heal a wound, BUT, you need to be sure that you know what you are closing, and be darned sure you aren't closing infection IN.

3. Clean the wound with lots of flushing (we use a dilute surgical scrub, or diluted betadine if around the eyes), and then apply either a suture or a staple to keep the wound from opening up further. Motion on a wound prevents the new healing cells from being able to form a supportive structure to allow it to close.

Whiskey allowed me to place one suture (I prefer them because I can get larger pieces of tissue and hold the wound together better than a staple, which is shallow, will allow. Therefore, she has 1 very solid deep suture, and four staples. Because we did not sedate or anesthetize her I did not suture it closed from top to bottom.

Whiskey went home with;

1. Pain medication, 7 days worth, $30.

2. Antibiotics 10 days worth, about $40.

3. E-collar about $15.

Whiskey's bill at my clinic was $185, which included the above and lidocaine $15, repairing wound $25, and initial examination $60. 

I will recheck Whiskey in 1 week. She may need the staples removed then, or it may take almost 2 weeks.

Related Blogs;

One Good Deed and Two Bad Dogs

Infection Trapped Beneath the Skin, Subcutaneous Emphysema

The Wounds That Lie Beneath, Dog Fight Victim.

A Pawbly member asked about how to treat their pets bite wound at home. I hope that this blog helps to explain why bringing your pet to the vet after a wound is so important. If you have a pet question, or any kind of pet experience that you think would help others, please join us at Pawbly.com. It is free and open to all pet lovers.

Any injured pet in the Northern Maryland area can find me at the clinic, Jarrettsville Vet, in Jarrettsville Maryland. Or follow me on Twitter @FreePetAdvice.

The Wounds That Lie Beneath. Dog Fights and Dire Consequences

There is a certain thrill in being involved in medicine. It is the mystery of the unknown, the deep rooted feeling of being able to improve a life, assist in comforting, and alleviating pain. It takes a little leap of courage every so often to do something that you have only read about, to diagnose and treat something a bit out of your comfort zone. But it allows you to grow, it strengthens your medical or surgical skills and it broadens your resume so that you can in turn assist more patients.

There are tiny pearls of wisdom that experience teaches you. These are some of the things that I hope this blog imparts. It is no different than the budding vet students life. You read, you study, you share, and when that fateful day arises a little bell will go off in your head and you will proclaim, "I remember something about this.." and a pets life will benefit from some pearl picked up by someone sometime ago.

This is Angus, an older Jack Russell Terrier who came to see me one Sunday. He was a quiet, timid, handheld package. He had been in a dog fight and was the apparent loser. I will admit that most of the dog fights I see are JRT's, and in almost all of the cases it is an older Jack who lives with other Jack's. Almost invariably the victim is the source of the instigation and the subsequent fight. The older dog challenging the younger kid but miscalculating their size, skill, agility, strength, and swiftness.

Jack's are highly energetic, possessive, fierce little dogs. They love their parents, bond very closely with them, but have a low threshold for other dogs. And, in most of the cases I see the bruised battered Jack lives with other Jacks whom they squabble with every so often over some possession. And every so often that squabble erupts into a battle of bites. They fight quick  and dirty. A grumble turns into a snap and two seconds later someone is bleeding and limping. I have sewn up more Jacks than any other breed combined.

Such was the case with Angus.

Like a true lifelong fighter, Angus has a graying muzzle, a few scars, scratches, and a look of pain and humility in his eyes. Clearly this isn't his first encounter with a disgruntled roommate, and clearly he needs to rethink his self entitled crown.

When I first assessed Angus my first impression was he was incredibly painful. He also refused to use his back right leg. These are signs of an injury that should be seen immediately.

Angus also had a large swelling to the abdomen at the top of his right leg. Of all of his puncture wounds, lacerations, and battle wounds this was the one I was most concerned about.

Here are some of the things that you should seek immediate attention for if your dog has been in a dog fight;

1. Trouble breathing. Always an emergency.
2. Trouble standing, or walking.
3. Cries or snaps when touched. 
4. Blue tint to tongue or gums.
5. Reluctant to lay down, sit down, or move.
6. Limping.
7. Seizure. Always an emergency.
8. Bleeding that will not stop with gentle pressure for 5 minutes.
9. Large and/or deep wounds.
10. Injuries to the eye, mouth, throat, chest, or abdomen.

That wound on his right side looked like this on the x-ray. The right side of the film is normal. The ribs run down the right side to the body wall and then to the pelvis. The left side however has a bulge of soft tissue to the left of the side of the pelvis.

That bulge the to left of the pelvis is Angus's intestines. They have escaped the confines of his abdomen from a rent (tear) in the abdominal wall.

If left untreated the intestines can strangulate and this will lead to death of the intestines and death of the rest of you.

Hernias can occur anytime there is a whole in the abdominal wall. We see them most commonly in the area of the belly button, inguinal hernia, or associated with a congenital abnormality. They should always be corrected surgically if any abdominal contents can, or are, slipping out of the abdomen.

The next day Angus had his abdominal hernia closed. He was kept on pain medications and antibiotics from the time I saw him through the first two weeks post-op.

He made a full recovery and will live to see another kerfuffle. The next time, hopefully, it will only be a verbal match.

If you have a pet question, or want to help other pets with your own pet experiences please join me on Pawbly.com. Pawbly is a community of pet enthusiasts who all work together to improve the lives of pets across the world. Pawbly is free to use and open to anyone who cares about helping pets.

You can also find me at the clinic, Jarrettsville Vet, on Twitter @FreePetAdvice, or on Google plus.

A Good Deed and Two Bad Dogs

Anyone of us kids that has ever grown up around another kid knows that sibling rivalry (even if you were an only child but had to go out to recess in school) exists in almost every arena we step foot in. We challenge each other in almost every relationship we have in life. I challenge my husband to do the dishes, he challenges me to not ask him to do the dishes. My puppy Charleston sees that Jekyll has a chewy and he stalks him to snatch it. Its almost unavoidable. We all have items that we covet and if you have another around you that shares the same interest a jealousy can arise, and the bigger, stronger, or bossier will usually challenge, and sometimes succeed.

For dogs this is especially true.

They are pack animals. Their communities have evolved to have an Alpha, or head honcho, dog. Here's the problem...that alpha only gets their alpha status by challenging the old alpha. This can be a BIG problem if you bring one pet into a household that already has a pet who thinks they are 'The Boss'.

Such is the story of Willow.

She is the resident of a retired couple who love her immensely. For many many years, Willow was their only child and they spoiled her willingly. Willow's life was perfect. She was given everything she wanted, she had her parents trained impeccably, and her house was HERS! No question.

Then the unthinkable happened.

Her next door neighbors got very ill and left their dog, (who she liked perfectly fine as long as she remained on her own side of the property line) to her parents. The neighbors dog was a corgi named Margaret. Margaret and Willow were alike in many respects. They were confident, independent, stubborn, opinionated spinsters.

Things seemed OK in the new household until the day they each realized that the other was not leaving..

From that day to today there have been two altercations. Both were precipitated unexpectedly. This has added a significant element of despair to the adults in the household.

On two occasions Willow has arrived at our clinic with two large gashes to her neck.

Many pets are possessive over food, or toys, or a particular item or scenario and when a family realizes that there are issues among the pets they go to great lengths to try to avoid the pieces of the puzzle that might cause a fight or challenge to occur. Over time these pets 'train' their families to reinforce the root of the problem instead of address and overcome it. For Willow's family they were perplexed about what was triggering the fights and they subsequently felt helpless to try to address the situation if they couldn't even begin to understand it.

The following pictures are from the second fight.

Margaret grabbed Willow at the neck, bit down, and pulled back. When she did it pulled the skin away from the underlying muscle, and made a big hole. That hole had an opening of a few inches but tunneled about a foot up to the spine and about 6 inches to the neck. That hole was so big that it required surgery to place a drain and close the wound.

Willow came in for surgery the next day.

The wound is an "L" shaped wound.
On the outside it doesn't look so bad, but there is a large open pocket under that flap.

A very large area of the neck had to be clipped and surgically prepared to place a long drain.

A large hole.

An old wound needs to have its edged "freshened" so that the sutures will hold and the edges will seal.

The entire wound edges have been removed.

The drain is placed and the wound is sutured closed.

The drain extends above and below the parameters of the hole.

A large t-shirt, or sweatshirt is a good way to cover a drain.
The shirt can absorb draining fluid and keep the pet from licking or removing the drain.

At home Willow received an antibiotic solution to be flushed AROUND the drain twice a day. This allowed any bacteria in the hole to be flushed out. She was also placed on an antibiotic and a NSAID for pain and swelling.


Willow returned ten days later to have the drain removed.

Willow healed very well.

I first learned of Willow's first altercation with Margaret from Pawbly.

Here is the question they sent me:

My dog was injured in a scrap with another dog. She is sensitive around her shoulders and I noticed bruising. What can I do to relieve the discoloration and soreness?

 Krista Magnifico, DVM responded ...

Hello Carol,

Thanks for asking your question.

I am sorry to hear that there was an altercation with your dog. Without knowing the extent of the injuries it is difficult to provide advice. Dog attacks and dog bites are some of the worst injuries I have seen. If there are puncture wounds (these can be very hard to see with fur, so look for any wet areas on the fur or places that your dog is licking, these are good clues). At the hospital we give a very thorough look over of any dog that has been attacked or bitten, and in many cases we shave the hair off of any areas that are injured. With hair covering a wound it is harder to treat, monitor, and heal.

If there is no evidence of wounds, but you are seeing bruising we assess the degree and extent of the bruising. Bruising is caused because the blood vessels in the skin have been traumatized and rupture. We have all had bruises. They in general will heal with time. But I have seen some bruising that causes subcutaneous emphysema. This is when the skin gets torn from the underlying tissue. This causes air to be trapped under the skin. It feels like plastic bubble wrap and sounds 'crinkly' when touched. These dogs tend to be very painful because there has been a substantial amount of tissue trauma.

My recommendation is to visit your veterinarian to insure that the tissue damage is not extensive. At my hospital after a thorough examination if there was only pain present I would probably recommend rest and an NSAID. NSAID's are non-steroidal anti-inflammatories. They are very good at controlling pain and reducing inflammation.

I hope that this helps, and I wish your pup a speedy recovery.

Oh, one last thing. In many cases dog fights erupt between pets in the same household. If this is the case I strongly recommend an intervention with a behaviorist. Because where there is one fight there are usually more to follow. Unfortunately I have many clients who have pets who are not friendly to each other. Managing the fits, fights, and wounds is expensive, scary, and stressful. If there are behavioral issues ask for help. Behavioral issues tend to worsen over time and manifest into other areas.

Sincerely,
Krista

Willow arrived at the clinic the next day. Here is what she looked like after we shaved the overlying hair.

A very large bruise (red) and dying tissue (black) at the site of the bite.

One of the most frustrating aspects of being a veterinarian is the behavior issues..Goodness, it seems that every other appointment is itchy pet or bad pet..and then the whole slew of emotional baggage that these problems bring.

Willow, Margaret, and their parents are all in behavior classes and in the long term care of a veterinary behaviorist to help identify the triggers and the issues to avoid any future fights.

If your pets are challenging each other, or injuring each other please see your veterinarian and ask for help.

And remember its never too late to teach an old dog new tricks..Even my husband and "thanks for doing the dishes, honey."