How to do Archives - Chappelle Veterinary Clinic

Background

Ticks carry a variety of diseases that affect pets as well as people (but are not contagious directly between pet and person). If the tick population is high in your area, it is important to treat your pet every month (or at the interval appropriate for the product you use) with a tick-preventive product. Ticks are harder to prevent than are fleas, and the most effective tick prevention products are available from your veterinarian rather than through pet stores. No products are perfect, however, and your pet might still have the tick attached. If so, you will be faced with the necessity of removing the tick. Tick removal is easy and can be done at home, but it must be done properly to remove the entire tick and not leave the head or mouthparts of the tick lodged in the skin. It is also important to prevent you from potential exposure to pathogens (germs) the tick may be carrying.

A tick’s head is dark brown or black (like the rest of the body of most ticks) and is very small—about the size of the head of a pin. The tick’s body can be a few times larger to hundreds of times larger, depending on how engorged the tick is with blood. What you see at first glance is the tick’s body; closer inspection is needed to see the small head of the tick, which is your target for removal.

Getting Started

Equipment/materials needed:

Forceps or tweezers (there are also special tools for tick removal)
Isopropyl alcohol (rubbing alcohol)
Antibacterial soap or diluted antiseptic such as povidone-iodine (Betadine) chlorhexidine
Gauze

Troubleshooting Beforehand

During removal or at any time, be sure to avoid squeezing the tick, which can inject the tick’s intestinal content back into the pet. Avoiding squeezing the tick means a lower possibility of disease transmission.

Be sure to remove the tick’s mouth, which is embedded in skin, and not just the body. When the tick is deeply embedded, the head and body could readily come apart if you are pulling on the tick’s body, leaving the mouth still in the skin. Therefore, extra care is needed to grasp the head of the tick directly at the surface of your pet’s skin in order to seize the tick’s head and remove the tick whole.

Procedure

Using forceps or tweezers, grasp the head of the tick flush with the skin, or even reach slightly into the skin with the tips, before closing the jaws of the forceps or tweezers (be sure not to squeeze the body). Then, gently pull straight out (do not twist).
Specific tick-extraction devices that have a notch into which the tick’s mouthparts slide for easy removal can be purchased at outdoor stores or some pet supply stores.
No aftercare is usually needed, but you can clean the area with gauze and antibacterial soap or diluted skin disinfectant.
Place the tick in rubbing alcohol; once it is dead (several minutes or more), place in the trash. An important exception is if your pet has recurrent infections with tickborne organisms. In that case, you should keep the tick in a sealed container, like an empty, clean margarine tub or Tupperware, and your veterinarian may wish to examine the tick itself. The tick can be classified according to species for a better assessment of the disease organisms it might carry.

Afterwards

Occasionally after tick removal, the skin may swell slightly, giving the appearance that a tick is still present. This tissue reaction to the tick’s saliva can be present for several weeks. Allow the swelling to decrease without picking at it. If it persists longer than 2-3 weeks, you should have it evaluated by your veterinarian.

Frequently Asked Questions

Should I wear gloves to remove a tick?

Wearing gloves is always a good idea, especially if the tick ruptures and blood from the tick coats your fingertips. However, with careful handling and handwashing after tick removal, gloves should not be required.

Which diseases can a tick transmit to my pet and me?

People and pets can catch a variety of diseases from ticks, including (but not limited to) borreliosis/Lyme disease, Rocky Mountain spotted fever, anaplasmosis, babesiosis, cytauxzoonosis, and ehrlichiosis.

Can cats get ticks?

Yes, despite myths to the contrary, cats can and do get ticks. Due to their fastidious grooming, they often pull ticks off themselves. That means it is rare to see large numbers of ticks on a cat. However, ticks can transmit germs quickly, and cats are susceptible to tick-transmitted disease. It is important to use regular tick prevention on cats as well as dogs. Be extremely careful to use only products approved for cats as products for dogs can cause dangerous toxicosis (poisoning) if accidentally applied to cats.

I have ticks all year-round at my home. Should I treat my dog with a tick preventive product monthly all year?

Yes. Ticks can be difficult to eradicate, so tick prevention should be year-round. With heavy infestations, products that target both eggs and adult ticks can be warranted, and your pets, pet beds, and your yard may require application of the anti-tick product by an exterminator or by you yourself. Such a thorough approach is useful when the tick burden is high, when there has been recurrent tickborne disease already, or when family-related factors increase the concern regarding tickborne diseases (for example, a member of the family is immunocompromised).

Removal of standing wood piles or trash, if any are present, is also valuable; these are common sites that harbor ticks in the environment. Storage rooms and kennels must also be treated, as they are often forgotten as a location that often harbors ticks.

Background

There are several aspects of immediate postoperative recovery that can make the difference between a quick, easy return to health or delays, complications, and an unhappy pet and family. In addition to caring for the surgical incision, there are many things you can do to promote a more rapid recovery for your pet after surgery. These include careful techniques for lifting the pet, providing a comfortable place for the pet to recover from surgery, and exercise restriction.

Getting Started

For some surgeries, veterinarians will prescribe pain medication for your pet’s postoperative recovery. Be aware that careful handling (when picking up or assisting your pet to stand) is still necessary to avoid causing pain. Some stronger pain medications can cause drowsiness, and you should be vigilant with regard to stairs, vehicles in traffic, and other hazards if your dog or cat is receiving pain medication that may decrease alertness (and risk a fall, being struck by car, or other causes of injuries that a sedated, recovering animal simply is not aware of). Additionally, your pet will need to rest after surgery. Even if your pet seems to be recovering quickly and wants to run soon after, a period of restricted exercise is recommended after virtually all surgical procedures. The type of surgery (simple versus extensive) will dictate the level of care and length of care necessary. In general, most straightforward surgeries of the skin (e.g., removal of a growth on the skin) heal in 10-14 days, as do elective surgeries like spaying and neutering. Surgeries inside the chest and orthopedic (bone/joint) surgeries may take several weeks of recuperation.

Troubleshooting Beforehand

In general, if your pet normally spends time indoors, it is best to continue this for the duration of recovery, allowing brief on-leash walks outside for urination and defecation. Usually, staying indoors is the easiest way to control the cleanliness and temperature of a recovering dog or cat’s environment, as well as limiting the level of exercise. If your pet is normally strictly outdoors, consider relocation inside or into a clean, protected outdoor area for the duration of recovery. If you are using a garage for this purpose, it is important to be sure that your pet is not exposed to ethylene glycol (antifreeze), rodenticides (mouse bait/rat poison), or other dangerous chemicals that may normally be stored there.

Procedure for Postoperative Home Care

When lifting a pet that has had surgery, it is best to start by assessing the pet’s pain level. Some overt signs to watch for include refusal to move on his/her own, flattening or pointing the ears backward, groaning, baring the teeth, or growling when you approach. More subtle signs indicating possible internal pain include hiding (cats), refusing food or water, avoiding eye contact, or having a hunched posture when standing. If your pet appears to be in severe pain or if your pet is known to nip or bite, use an appropriately sized muzzle (restraining device placed over the snout) if it becomes necessary to lift your pet. Further detail is available in a separate information sheet (see below).

To lift a large dog, one good option is to use a towel or bedsheet as a sling running across the underside of the abdomen (belly). Ideally, two people are involved, one to lift each end of the sling and elevate the hindquarters; the dog should have a surface with good traction and should attempt to stand. With this assistance, standing and walking are possible.

To lift a small to medium-sized dog, place one arm under his/her hind end or pelvis (as if your pet could sit down in the crook of your elbow), and wrap the other arm in front of the chest and shoulders. This can be described as a gentle “bear hug.” If your pet is slightly too heavy for this approach, slipping the second arm under the chest can provide additional support, provided it is not strenuous or risky for your own back/health.

To lift a very small pet such as a small dog or a cat, place one hand under the pelvis (hips, hind end below the tail), cupping the hind end with your hand, and place one hand in front of the shoulders or under the chest.

These approaches to lifting are ideal for patients with abdominal incisions, leg injuries, head and neck injuries, and most other wounds on their trunk (abdomen and back). For a dog that has had back surgery, the techniques described above may or may not be appropriate depending on the nature of the surgery. You should ask your veterinarian to review and demonstrate a correct approach (providing maximal support to the spine) with you prior to discharging your pet from the hospital.

Keeping your pet in a warm, clean, comfortable, and protected area (from weather extremes and from other animals) allows your pet a quiet opportunity to rest without the need to move excessively. A soft bed on the floor in an area of the house that can be gated off may suffice (to keep the patient in and other pets out). For pets that have had more serious injury or surgery, when strict exercise restriction is imperative, keeping your pet in an airline kennel or other approved pet cage may be required to avoid wrong movements or self-harm. Under any of these circumstances, a minimum of two sessions of standing (with assistance) and walking should be planned every day. See Other Related Information Sheets, below. Cats are often much smaller than dogs, so it may be necessary for your cat to have more space, such as a room of his/her own. Cats often need a quiet area without any competition with other pets for food, water, or the litter box during their recovery. Many cats appreciate having a hiding place, like an empty cardboard box, to hide in, and you should cut a hole in the side of the box so the cat can enter and leave easily.

In general, exercise restriction for dogs includes short on-leash walks for the purpose of urination and defecation. This means restriction from using the stairs, running, jumping (in and out of cars/trucks, on and off your bed and couch/other chairs) and playing, even if your pet appears to be recovering very quickly.

The appetite can return quickly or only gradually after surgery. In most cases, the first meal should be 12 hours or so after surgery. It is wise to offer a small portion (1/4 the usual amount), because having had food withheld prior to surgery means eating a full meal could be excessive and cause nausea. Passage of food from the stomach into the intestines can be expected to be done in 3-6 hours, at which time another quarter-meal can be given. This can be repeated for a total of four quarter-meals to finish the day’s feedings. Then the regular feeding schedule resumes the next day.

Afterwards

Depending on the type of surgery, recommendations for exercise restriction will vary widely from 1 week to several months. Contact your veterinarian for recommendations specific to your pet’s surgery.

Several types of surgical interventions, such as eye surgery, heart surgery, and others, require special monitoring. Please ask your veterinarian if any special monitoring is recommended.

Frequently Asked Questions

My pet hasn’t had a bowel movement for 24 hours since surgery. Is there a problem?

No, this is essentially always normal. During recovery, a pet usually has a decreased appetite. When he/she eats less, there will be less of a need to defecate. Furthermore, most surgeries are preceded by a period of fasting (withholding food), which further reduces the need to defecate. However, it is important to monitor for a progressive return to his/her normal appetite and passing normal urine and stools over 24-48 hours postoperatively. If your pet continues to have a poor appetite, this may be due to a problem such as inadequate pain management. Contact your veterinarian to discuss these concerns.

Are there any vitamins or supplements I should give my dog or cat to help with recovery?

This is a highly controversial area, with many companies selling products that make promises of accelerated recovery based on testimonials, hearsay evidence, and information that is simply unsupported. With a balanced diet and ongoing treatment of any concurrent medical concerns or illnesses, no specific supplementation should be necessary.

Background

Recovery from muscular, bony, or joint injury or surgery in animals often includes a gradual return to movement, just as it does in people. Doing very gentle, full range flexion and extension of the limbs several times daily is a form of physical rehabilitation that can keep the muscles limber and the joints flexible. It is an opportunity for you to help speed the recovery in a hands-on way with your pet.

While some veterinary facilities can offer some forms of physical rehabilitation, such as walking on an underwater treadmill, the hands-on approach of gently and repetitively moving a pet’s limbs through their normal movements can be done at home. These are range-of-motion exercises and are appropriate for both cats and dogs.

Getting Started

It is best to choose a place in the home where a pet can stand or lie down on his/her side comfortably. There should be traction for exercises requiring a pet to stand. Carpeted areas are well suited so long as they can be kept clean. A rubberized, padded mat that is at least twice as long and twice as wide as the length of the pet can also work well. For pets with thin or fragile skin, a large foam cushion or foam rubber sheet can be helpful as padding.

Usually the exercises should take between 5 and 10 minutes to do each time, and in most cases it is recommended to do them 3 times a day (about every 6-10 hours). Overall duration can be a few days or several weeks, depending on the extent of the original surgery/injury. Some disorders (e.g., polymyositis) can require very frequent and very gentle exercises for many weeks, whereas others (e.g., fracture with complete surgical correction) only require a brief course of exercises. Your veterinarian can make this determination.

Going slow, especially at first, is important. One full extension or one full flexion of any joint in any leg will likely take from 10 to 30 seconds the first time. With practice (and the patient’s flexibility), 5-10 seconds should eventually be typical for each exercise, keeping in mind that the end of each motion is slower when resistance is met, watching for signs of discomfort (raising the head, shaking the leg away, or vocalizing).

Troubleshooting Beforehand

Range-of-motion exercises usually are started within 1-3 days of injury/surgery: soon enough to start to help, but after severe swelling has had a chance to stabilize and start to resolve, and healing has started. Be sure that your pet is comfortable enough to start. If severe pain is present, do not attempt these exercises, and contact a veterinarian to discuss alternatives as well as pain control.

Each exercise usually is performed 15-20 times each session. If there are signs of pain or resentment, stop and allow your pet to rest for several seconds before trying again. Some pets learn to object in order to get more attention, whereas others are in real pain. If you are having difficulty with the exercises, be sure to contact your veterinarian to decide how to proceed.

Procedure: How to Perform the Exercises

Forelimbs (Front Legs)

Like us, dogs and cats have shoulders and elbows. The shoulder can be felt as a bump on the front of the animal, to the outside surface of the chest and base of the neck. The elbow is slightly farther down the forelimb and is the part of the forelimb that points the farthest backward. Forelimb exercises focus on movement at the shoulder joint and elbow.

The goal will be to gently flex and extend the front leg that is on top (not the one against the ground). The left leg is used as an example here, with the pet lying on his or her right side, and the same process, reversing all left and right, can be used for the right leg when your pet is lying left-side down.
With your pet lying down on his/her right side, kneel or sit between the forelimbs and hindlimbs (beside the belly, between front and back legs) facing forward, in the same direction as the pet is facing.
Shoulder flexion/extension: Lay your right hand over the left shoulder, with the pointed part of the shoulder in the palm of your right hand. Cup the left elbow in the palm of your left hand. Push the left front leg forward gently with your left hand while holding back the shoulder in one place with your right hand. Extend the leg this way until you meet mild resistance. At correct full extension, the front leg will appear as if the pet is in full stride with that leg (pointing straight ahead). Then release gently (1-2 seconds).
Next, grasp the same leg between the shoulder and elbow, using your left hand wrapped around the entire diameter of the leg. Flex the shoulder simply by gently drawing the leg backward and up toward the back. There is no need to lift the leg outward (toward you or toward the ceiling); the correct motion is a rotation of the leg toward you, in the opposite direction from the extension exercise described above. Only your left hand should be needed, although you may place your right hand on the pet’s back to help your left hand bring the leg up to a flexed position. At full flexion, the elbow should be pointing to the tail or the back. Release gently (1-2 seconds), and repeat flexion and extension, alternating from one to the other, 15-20 times for 1 session.
Elbow flexion/extension: With your pet lying on his/her right side, use your right hand to hold the leg between the shoulder and elbow (firm grasp, like holding a flashlight) and your left hand to hold the same leg but on the other side of the elbow (farther down the leg). Flex the elbow joint by bringing your hands close to each other until you meet mild resistance. At full flexion, there should be no discomfort for your pet, but the knuckles of your hands should be touching or almost touching each other. Then perform the opposite movement (with hands still in the same position) by opening the angle of the elbow completely and extending the leg until you meet resistance. At full extension of the elbow, the whole front leg will form a straight line (180 degrees). Repeat from full flexion to full extension 15-20 times.
To perform these exercises on the other front leg, allow your pet to right him/herself onto the chest, and then roll him/her carefully onto the other side, left-side down. You can then follow the instructions as described above, reversing all rights for lefts and lefts for rights.

Hindlimbs (Hind Legs, Back Legs)

Dogs and cats have one hip joint and one knee (referred to as a stifle) in each hind leg. The hip is concealed by muscles and skin but can be felt in most dogs and cats as a bump on the outside upper surface of the right and leg thigh. The knee is the joint in the back leg that is located below the hip and points forward; the knee is above the hock (the joint in the back leg that points backward). Hindlimb exercises focus on movement at the hip and the knee.

The goal will be to gently flex and extend the back leg that is on top (not the one against the ground). The left leg is used as an example here, and the same process, reversing all left and right, can be used for the right leg when your pet is lying on the other side.
With your pet lying on his/her right side, kneel or sit between the forelimbs and hindlimbs (beside the belly, between front and back legs) facing backward, away from your pet’s head.
Hip flexion/extension: Gently grasp the left hind leg below the knee, which will be a slender and bony part of the leg (the tibia), using your right hand and with the same grasp as when holding a flashlight. Push the leg forward—toward you and up in the direction toward your pet’s back—using your right hand. This should cause the knee to come toward you and the thigh to move upward toward your pet’s back (hip flexion) until you meet resistance. At full flexion of the hip, the thigh should be parallel to the spine. Then release gently over 1-2 seconds.
Next, maintaining the same grasp, draw the hind leg away from you, possibly helping with some pressure applied on the thigh (pushing backward, away from the head) with your left hand until you meet resistance. This is extension of the hip, and at full extension, the hind leg will appear to be pointing straight back, parallel to a straight tail. Release gently over 1-2 seconds, and repeat the sequence of flexion and extension 15-20 times for 1 session.
Knee flexion/extension: With the pet lying on his or her right side, grasp the thigh with your right hand and the lower hind leg with your left hand. Without moving the hip, flex the knee by pulling the lower hindlimb toward the upper hindlimb. At full flexion, the thigh (femur) will touch the lower hindlimb (tibia). Next, extend the knee by pulling the lower hindlimb away from the thigh. At full extension of the knee, the thigh and the lower hindlimb will form a straight line (180 degrees). Repeat 15-20 times.
To perform these exercises on the other hind leg, allow your pet to right him/herself onto the chest, and then roll him/her carefully onto the other side, left-side down. You can then follow the instructions as described above, reversing all rights for lefts and lefts for rights.

Afterwards

These exercises work best when a dog or cat enjoys them. Offering a special treat after each session or spending additional time with the pet to give attention as a form of reward can make the experience more pleasant and easier to do.

These exercises help keep the major muscle groups and main joints of the legs limber. They should not be painful, and any sign of discomfort (or any inability to complete them) warrants a discussion with your veterinarian about alternatives.

Frequently Asked Questions

I’m not sure my dog/cat likes me doing this. Should I continue?

Initially, any dog or cat may feel unsure about a new activity like these exercises, as do most people. By following the described procedure, both you and your pet can become more comfortable and get more out of doing this after a few days. Consultation with your veterinarian is absolutely appropriate if any uncertainty persists. If you find that limping is worse rather than unchanged, or there are obvious signs of pain when you and your veterinarian do these range-of-motion exercises together during a recheck appointment, then it may be necessary to stop.

I can’t do it three times a day. Is some better than none?

Yes, even once a day is better than none. Once a day, or less than once a day, risks allowing some muscle atrophy, so the result will be less optimal. Still, every session helps, and going slow is even more important when the exercises have not been done for a day or more.

Background

If your pet recently has been diagnosed with diabetes, home monitoring of your pet’s blood sugar (blood glucose) can help your veterinarian make sure the correct amount of insulin is being given. Measuring glucose if your pet seems “off”, or not quite themselves, can also help rule out low blood sugar related to insulin administration.

Checking the blood glucose levels at home is easy and can provide more accurate results than when the pet arrives at the veterinary hospital. Many pets become stressed when visiting the hospital, which can temporarily elevate the blood glucose and give an inaccurate reflection of the diabetes. This is especially common in cats.

Monitoring the blood glucose levels is easy. It can take some time to become comfortable with the technique, but it is important to understand that it is a safe and comfortable procedure.

Getting Started

Equipment/materials needed:

Recommended blood glucose home monitor (veterinary specific monitors are preferred)
Glucose strips
Sterile lancet or needle
Cotton ball
Alcohol
± Petroleum jelly/Vaseline

Troubleshooting Beforehand

You should not attempt to take a blood glucose reading when your pet is agitated or stressed. Your veterinarian will indicate the times you should check the glucose levels. Sometimes, a blood glucose curve will be recommended whereby several readings will be needed throughout one day.

You should be able to complete this procedure alone. However, if you have a pet that is active, you may need the help of another person to keep the pet still for a few seconds. If your pet becomes difficult to handle, discontinue the process and call your veterinarian to discuss other options.

Procedure

In cats, place a cotton ball on the nonhaired (inside) surface of the ear flap, and hold it in place with your left thumb and forefinger if you are right-handed. The cotton ball provides a buffer to reduce the risk of needlestick injury to yourself. The process is the same in dogs, although dogs with thick haircoats may first need to have the hair shaved away from a patch of the ear flap.
For dogs, there are multiple other sites beside the ear flap that can serve the same purpose for obtaining blood. You can see which site works best for you and your dog. For dogs with a callus (thick dark skin) over the elbow, this is an excellent option. Other options include the side of the paw pad or the inner lip.
Apply a thin film of petroleum jelly/Vaseline to the outermost 1/4 to 1/2 inch, or 0.5 to 1 cm, of the ear flap (margin), on the haired side, directly where you will be pricking with the needle or lancet. This very thin film will cause the blood to bead on the skin surface, making it easier to collect.
The goal is to get a drop of blood from the raised, branch-like network of blood vessels just below the skin surface. This is painless because no significant nerve endings are in this region.
Take the needle in your right hand and place it horizontally so the tip is touching the raised blood vessel that arcs around the margin of the ear flap, on the haired side. DO NOT aim the needle perpendicularly (directly at) the surface of the ear flap, because you risk going through the ear flap entirely and injuring your own left finger with the needle.
Prick the tip of the ear with a sterile lancet or needle. This is a quick, superficial prick meant to draw a tiny amount of blood (1 small drop). The depth of the prick is very little but still deep enough to reach the small vein. In a cat this means approximately 1 mm ( of an inch); in a large dog with thick ear flaps, like a golden retriever, the needle prick may extend to 5 mm ( of an inch). This should be absolutely painless.
Place the glucose strip on the drop of blood, and insert the glucose strip into the meter according to the instructions for that device.
Place mild pressure on the ear flap directly on the site of the needle prick for 30 to 60 seconds to stop bleeding.
Record the reading.

If your pet’s glucose reads “low” or less than 50 mg/dL (2.8 mmol/L), you should contact your veterinarian to discuss whether an immediate treatment is necessary. If your pet’s glucose reads “high” or greater than 300 mg/dL (16.7 mmol/L), you should likewise call your veterinarian. A low glucose can sometimes require immediate attention; a high glucose is not an immediate emergency, but your veterinarian must be notified because it can cause deterioration of the diabetes over time. You will be given instructions on how to proceed.

Afterwards

Many or most pets become accustomed to having blood glucose sampled this way. Make sure to reward your pet with a diabetic-friendly treat after each blood sampling to make this a pleasant experience they eventually may look forward to. (Store-bought processed dog and cat treats are often high in calories and fat and can adversely affect glucose levels, so these should be avoided.)

You should keep a diary of all blood glucose readings you obtain at home. This should include the date, the time of day the reading was taken and for comparison, also the time of day insulin was last administered and the pet fed. Be sure to give your veterinarian a copy of this diary at your next visit.

Although home blood glucose readings are extremely useful for dose adjustments made in consultation with your veterinarian, avoid the temptation to change the dose based on a single glucose reading on your own. Fluctuation in dosing can wreak havoc with blood glucose control. Unlike human diabetics, fine hour-to-hour control is not necessary. Instead, steady control is the goal. If you think the readings you have been getting are too low or too high, contact your veterinarian for advice.

Make sure your pet is receiving an appropriate diet recommended by your veterinarian for the treatment of diabetes. It is very important to regulate your pet’s food intake. Ensure your pet is exercising regularly, as exercise can affect glucose levels. Your pet’s food, insulin, and exercise schedule should remain the same every day, preventing false elevation or a decrease in glucose levels.

Frequently Asked Questions

If my pet does not eat, should I check the glucose levels and give the insulin?

If your pet does not eat for one meal, you should only give a half dose of insulin. You can check the glucose levels, making note that your pet did not eat that meal. If your pet will not eat for 24 hours, you should call your veterinarian.

What if the bleeding does not stop on the tip of my pet’s ear?

Hold pressure on the tip of the ear for several minutes. The bleeding will stop in virtually every case; if not, you should contact your veterinarian.

My pet seems very weak. Should I check the glucose level?

Yes. If the glucose is low, offer your pet food immediately and call your veterinarian. Do not give insulin at that point.

Is it safe to prick the same location of the ear each time?

It is advised to switch ears with each prick. You may change the location so long as it is anywhere on the nonhaired surface of the ear flap, preferably toward the tip.

View of the haired side of the ear flap (pinna) in a cat. Note the branch-like pattern of raised veins near the margin.

Correct use of a needle to draw a drop of blood from the ear vein. The needle is directed horizontally across the ear flap, to enter the vein from the side. This is to avoid a needlestick injury to yourself.

Background

The normal healing process of any wound involves mild inflammation of the skin: a rosy pink color is expected along the edges of a surgical incision while it heals. However, excessive inflammation, swelling, and drainage of fluid from the incision are cardinal signs of infection, which can be a potentially serious (and common) complication after surgery. Identifying excessive inflammation early can prevent complications. Therefore, it is important to be able to identify excessive inflammation and signs of infection, and the goal of the summary here is to explain how to do this as well as how to minimize the risks of infection before a problem occurs.

The term suture is the same as “stitches.” Some sutures are made of a material that is absorbable. These are under the skin or in the body and are not visible. They do not have to be removed because they dissolve over time. More commonly, sutures are nonabsorbable and are visible on the surface of the skin. Alternatives to nonabsorbable sutures are “liquid sutures” (tissue glue), which bond the skin together when the incision is small (and need not be removed), and steel surgical staples, which must be removed like nonabsorbable sutures but using a special staple remover clamp. Any of these kinds of suture is acceptable, alone or in combination, for surgery in dogs and cats. Any nonabsorbable sutures or staples will have to be removed by your veterinarian or veterinary technician once he or she has determined that the incision has healed.

Getting Started

The process of monitoring an incision is simple: no equipment or materials are needed, only a well-lit area to see the incision and a repetitive routine for consistent monitoring.

Checking your pet’s incision morning and night, every day for the first 7-14 days after an operation, will allow you to see the healing process. This will also provide you with the opportunity for early detection of infection or irritation. Ideally, you should ask your veterinarian or a veterinary technician to look the incision over with you before leaving the veterinary hospital. If this makes you uncomfortable, it is a good idea to ask a family member or friend to be there and to help with the monitoring.

Looking at your pet’s incision when you first get home from the veterinary hospital will provide you with a baseline mental point of reference. Continue to inspect the incision each morning and night, and more often if your pet is showing an interest in licking or scratching it or if you detect any abnormalities in the incision or your pet’s behavior.

Some types of incisions/wounds require placement of drains. A drain is usually a thin, flat, latex tube that is secured with sutures under the skin and soft tissue. It allows fluid to drain around it (not just through it) so tissues can heal appropriately.

Although your pet’s incision may look very securely repaired immediately after surgery, pets can take out external and internal sutures as well as drains quickly through licking or scratching. There are various options to help you protect your pet’s incision from licking and scratching, including Elizabethan collars (lampshade-type collar), T-shirts, bandages, or covering the paws with soft fabric (socks). Sometimes one or more of these protective measures is needed, depending on a pet’s personality and energy level. It is just as important to protect an incision from other pets in the house that might lick it. An easy way to avoid extra visits to your veterinary hospital is to be committed to monitoring and protecting the incision as it heals, which is typically a 2-week period of time.

It is common to receive prescriptions of antibiotics and pain medication to give to your pet during his/her recovery. While they are not required in every situation, when these medications are prescribed, it is important to give them as instructed by your veterinarian (and on the label) until they are finished. Antibiotic therapy when an infection is suspected or confirmed, pain medication, and incision monitoring are all important means to support a healthful recovery.

Troubleshooting Beforehand

Frequently the activity level that is normal for your pet would be enough to cause extra oozing or swelling at a surgical site within the first several days after surgery. To avoid these complications that delay healing, it is best to restrict exercise to a few on-leash walks daily during recovery. If your pet is very active inside the home, then restriction to a kennel or crate may be necessary.

If you notice that an incision is turning darker red, is oozing more than when you first came home from the veterinary hospital, the margins of the incision appear to be coming apart, or your pet refuses to eat, is restless, is trembling or becomes obsessed with trying to lick the incision, there may be a problem. It is possible that the incision has become infected, is painful, or both. Your pet may need additional treatment, and if you observe any of these symptoms, you should contact your veterinarian promptly to determine if an immediate recheck is necessary.

Procedure

Look at your pet’s incision in a well-lit room. If the incision is on the abdomen (belly), for example, carefully roll him/her over onto his or her side, keeping the four legs bunched together to avoid stretching the belly wall, and then slowly release the legs and examine the belly so you can inspect the incision clearly and completely.

When looking at the incision, be sure to note the color of the skin at the incision line, the amount of swelling in the area and surrounding areas, and whether or not there is any discharge (oozing of fluid). One helpful tip is to take a photo of the incision on the first day home so you can compare objectively in the future by looking back at the original photo for comparison.

Color

At the incision edges, the skin may be pink to light red initially. Monitor for fading of these light colors back to the normal color of the skin, which is normal for healthy healing. If the color of the incision appears to intensify over time (from light red to dark red), an infection may be developing. Bring these changes to the attention of your veterinarian immediately. It is possible to have some bruising in this area as well. These findings should lighten and resolve over the next several days of recovery. It is normal for a bruise to change from light red to purple as it heals. However, if you notice that new bruising develops that your veterinarian was not aware of, it is important to alert your veterinary staff immediately.

Swelling

Mild swelling can be expected at an incision site immediately postoperatively. The amount of swelling depends on the type of surgery and the reason for the surgery. A routine surgery may have minimal swelling, whereas a traumatic injury repair may have more. If swelling progresses rather than resolves after surgery, tell your veterinarian.

Discharge

The amount of fluid that oozes from an incision depends not only on the reason for the surgery but the location of the incision. Your veterinarian can discuss the amount of discharge you can expect to see with your pet’s specific incision. The discharge is normally light red in color. A change in color of this discharge from light red to dark red (like blood), together with an increase in amount of fluid discharge and a reddening of the incision edges, may indicate an infection is developing. If the color of the discharge becomes yellow, white, or green (like pus), an infection is almost certainly present, and a recheck examination of this surgical site is necessary to identify the best treatment.

If your pet’s wound repair required a drain, routine cleaning will likely be necessary. It is preferable to use sterile gauze moistened with povidone-iodine (Betadine) solution, diluted with tap water to a light tea color, or chlorhexidine solution (light blue or pink, may be provided by your veterinary hospital) for lightly wiping or dabbing the incision or drain for cleaning. It is good to carefully remove dried discharge from an incision and around a drain, because caked discharge may seal a drain closed and stop the draining process. It may be easier to clean and more comfortable for your pet to first hold a very clean, warm washcloth to the area for several minutes to moisten and soften any dried discharge.

Afterwards

When drains are placed as part of a surgical operation, they generally should be removed 3-5 days later. When they are removed is based on when the wound is done draining. This will be determined by your veterinarian or veterinary technician prior to removal, but you should keep track of whether the amount of fluid discharge from a drain is increasing, decreasing, or staying the same over time. This will help with the decision to remove a drain or leave it in place for a few more days.

Sutures and staples are usually removed in 10-14 days. Sometimes an incision may look healthy on the outside when in fact it has not actually finished healing. It is important to return to your veterinary hospital for the suture removal so your veterinarian or veterinary technician can examine the incision and ensure it has properly healed prior to suture removal. If an incision has not completely healed, the veterinary staff will be able to respond quickly and provide you with a new time line for continued care.

Frequently Asked Questions

When does the pain from an incision go away?

Generally, pain from a skin incision is almost completely gone in 24-48 hours. If your pet appears painful longer than this, please contact your veterinarian. A recheck examination may be necessary. However, the itchiness of an incision healing starts a few days after surgery as well. It is common for a pet to start showing interest in licking an incision after being home.

There are no stitches on the outside (my doctor said they are internal and will dissolve). Is the same monitoring required?

Yes. It is just as important to protect these incisions from licking, scratching, and infection while they heal. Occasionally, especially if the dog or cat licks the incision, internal stitches can protrude through the skin. This is a direct portal for infection (wicking effect), not to mention a risk for the stability of the whole incision. Therefore, prevent any licking or chewing of the incision, and if you believe there is suture material visible when it was not visible previously, contact your veterinarian for a prompt recheck.

A few stitches are missing from my pet’s incision, but I didn’t see him/her lick it. What do I do?

It is often best to call your veterinary hospital, alert them to the issue, and discuss your pet’s specific type of incision. Some situations will be solved by simply using more protective measures (see “Getting Started” above), while others will require veterinary attention.

I thought a dog’s mouth was clean. Isn’t licking the incision just a natural way to clean it?

This is one of the most hard-held folk tales in veterinary medicine. Actually, both dogs’ and cats’ mouths are loaded with bacteria, which require a copious amount of immunoglobulin (antibodies) to be produced in the mouth. The folk tale only considers this last part, the antibodies. The action of licking transfers both bacteria and antibodies onto the incision; the bacteria multiply but the antibodies do not, and this is how an infection begins. Licking also causes itchiness that stimulates more licking. For both these reasons, all pets need to be prevented from licking their skin incisions for at least 10-14 days after surgery.

Background

A seizure (sometimes called a convulsion) is a sudden neurologic event that causes changes in consciousness and repetitive involuntary movements of parts of the body. Pets may experience seizures for a number of reasons, including ingestion of poisons, low blood sugar, inflammation or masses involving the brain, head trauma, severe liver disease, or epilepsy, to name a few. At the beginning of a seizure, a pet lies down or collapses onto his/her side because seizures produce an altered state of consciousness. A seizure can then produce symptoms such as a rigid body posture; jerking, “running,” or “paddling” movements of the limbs; lifting of the lips and very rapid movements of the jaws (“gum-chewing”); vocalizing; and loss of control of the bowels and/or urine.

The goal of managing a pet’s seizure at home is to provide a calm, safe environment to allow the seizure to finish, and to intervene if the seizure lasts a long time.

If there is a specific metabolic imbalance that has been documented previously and that can be reversed to help the seizure, then you should do so as soon as the seizure begins. A common example is a hypoglycemic seizure (seizuring due to low blood sugar), which can occur in diabetic animals receiving insulin. You can treat these seizures with oral sugared syrups (see below).
If a seizure lasts more than 5 minutes, you should notify your veterinarian (or animal emergency clinic if after hours) and bring your seizuring pet for immediate treatment.

Troubleshooting Beforehand

It is vitally important for you to protect yourself and others from being bitten during a pet’s seizure. During a seizure, a dog or cat has no awareness of what he or she is doing. The “gum-chewing” jaw motions that seizuring pets make are without conscious control and are extremely powerful. You must absolutely keep your hands and face away from the pet’s mouth during and immediately after the seizure activity. During a seizure, the jaws can clamp down on a hand or other body part and not let go; these bites are highly damaging and can cause the loss of fingers or disfiguring injuries.

An old folk tale describes seizures as causing an animal (or person) to swallow their tongue. This is impossible and a myth that probably arose from the gurgling or gagging sounds seizures cause. The important point is that you must not try to touch the tongue or pull it forward: there is no need, and trying to do so can cause you to be badly injured because the chewing motions during a seizure are uncontrolled and potentially harmful.

Sustained seizure activity, called status epilepticus, can start to become dangerous after 5 minutes or longer of continued vigorous seizuring. The constant muscle activity of seizures generates heat, which increases body temperature. If a seizure has been ongoing for 5 minutes or more, especially in warm weather, be sure to try to terminate it with veterinary antiseizure medication (as described below), or bring your seizuring pet to an emergency veterinary center without delay.

When seizures occur in water, there is a significant risk of drowning. This is not so much a concern with water bowls, which would be pushed aside by the seizuring motions of the patient, but can be serious with swimming pools, lakes, ponds, beaches, and the like. Dogs known to have seizures should not be allowed to play unsupervised in water or near pools, but rather should be watched and should be within immediate reach should a seizure begin. A good option is for you to be in the water with the dog, with a long, retractable leash on the dog so there is room to play, but you are still connected and able to pull him/her to safety if a seizure begins.

Procedure

First and foremost, when a seizure occurs, do not panic. Realize that seizures produce an altered state of consciousness. Even though seizures may look dramatic to you, your pet—like a person who has an epileptic seizure—will not remember it happened.
Move quickly to take your pet away from immediately dangerous situations, in the rare event that a seizure occurs in a hazardous location. Examples could include the edge of a steep drop-off on a hiking trail, a busy roadway, the top of stairs at home, or in water. When a seizure begins near one of these potential hazards, take your pet by the collar, the scruff of the neck, or the hind legs and drag him/her away from the hazard. For waterborne seizures, drag your dog immediately onto shore or onto a boat or platform. In all situations, be sure to protect yourself from being bitten. This may involve picking your dog up by the hind legs rather than the collar to pull him/her to safety without approaching the head and teeth.
Most seizures last only seconds to minutes; however, those seconds or minutes may feel longer than they really are. Be sure to look at a clock/watch at the beginning of the seizure so you will know how long it lasted. It can also be helpful to report how long the event lasted to your veterinarian.
As described above, seizures that last 5 minutes or more require antiseizure medications. DO NOT administer human antiseizure medications if you have them on hand, unless your veterinarian counsels you to do so. Unguided administration of human antiseizure drugs can easily cause an overdose that could be life-threatening.
One effective at-home method owners can use is to give diazepam (Valium) rectally to the pet during a seizure. This is because the violent “gum-chewing” motions of the mouth make oral administration impossible, and the flailing of the limbs makes intravenous injection into a leg vein equally unlikely. For rectal diazepam/Valium administration, the directions are as follows:
- When the seizure begins, open a vial of liquid diazepam/Valium. If it is in small, single-use, all-glass bulbs, be very careful not to cut yourself on the sharp glass edge of the crack-off bulb top (use a square of gauze or a facecloth between your fingertips and the bulb when opening). If you are using a bottle of diazepam/Valium that has a round plastic cap on top, pry it off to reveal a round rubber stopper on top (often gray, surrounded by a flat metal cap, shaped like a washer).
- Place a needle onto a syringe. Typically this means removing both the needle and syringe from their wrappers or casings and removing their protective caps.
- Use the needle and syringe to draw up a single dose of diazepam/Valium from the vial as prescribed previously by your veterinarian for this use.
- Carefully remove the needle from the syringe, and discard the needle safely for proper disposal as medical sharps. Be sure to do this slowly and correctly to avoid giving yourself a needlestick injury.
- If it was provided to you, you may place a plastic teat cannula, which is a small nozzle-like tip, onto the syringe where the needle was. Otherwise, the procedure can continue just fine without it.
- Lift your pet’s tail with one hand (left hand if you are right-handed) and take the syringe with the diazepam/Valium with the other hand (right hand if you are right-handed), holding the syringe like a pen. Do not have your thumb on the plunger of the syringe; rather, just hold the barrel of the syringe with the first three fingers, like you hold a pen.
- Rest the palm of your hand holding the syringe on your pet’s hind end, below the tail, such that you can place the tip of the syringe into the anus just by turning your wrist and pushing the syringe tip into the anus gently.
- Advance the syringe into the anus, being sure to advance the barrel of the syringe (the whole syringe); do not touch the plunger (white plastic part of the syringe that injects) until the syringe is advanced well into the anus.
- When the barrel of the syringe is halfway or more into the anus, remove your thumb from the barrel of the syringe, leaving the syringe held between your second and third fingers like a cigarette; move your thumb up to the plunger and depress the plunger to deliver the diazepam/Valium in one dose. This does not have to be especially fast or slow (1 or 2 seconds is fine).
- The effect of the medication should be seen in the form of slowing of the seizure and then termination of the seizure within 3 to 5 minutes of administration (total seizure time: less than 10 minutes).
Another option is to administer sugar syrup by mouth, but only if the seizure is known to be caused by low blood sugar. The two situations where this may occur are diabetes (mellitus) that is being treated with insulin, and certain types of tumors that decrease blood sugar levels, such as insulinoma and smooth muscle tumors. Be sure to check with your veterinarian before giving sugar solutions in an attempt to treat seizures.
- Move the seizuring pet to a nearby easily cleaned surface such as a tile or linoleum floor.
  
  Pour corn syrup or maple syrup into a spoon: to 2 teaspoons (2 to 10 mL) is appropriate for cats/small dogs to large dogs, respectively.
- Hold the spoon in your right hand if right-handed; with your other hand, hold the seizuring pet’s lip up to completely expose the gums on one side. This is most easily done by taking the whiskers and gently pulling to lift the lip. Do not put your fingers on the gums or in or near the mouth, as you may be severely injured through biting.
- A seizuring pet will virtually always be lying down on his/her side. Therefore, pulling the lip up and exposing the gums allows you to drip the syrup onto the gums. Some of it will often run through and onto the floor, but some can be absorbed by the gums or may be swallowed if your pet is licking.
- If your pet’s seizure signs are mild and he/she is still sitting up or standing, you may instead put the spoon into the cheek pouch, which is the corner of the lips on either side of the mouth. Putting the syrup here is best for your pet to swallow it. Be sure to handle the lips or cheeks only by pulling on the hair of the face, not by handling the edges of the lips or putting your fingers inside the cheek pouch, any of which can result in your getting bitten.

Afterwards

Pets may be disoriented for some time after the seizure has ceased. This is to be expected and is referred to as the postictal period. Due to this disorientation, pets may not recognize their owners or other family pets. These signs generally will slowly disappear over the next hour/hours. Pets may also appear blind and may bump into objects. This too should disappear over minutes to hours, but your pet is reliant on you during this time to protect him/her from hazards such as stairs or objects that can topple if bumped into.

If a pet is receiving daily medications for seizures, you should contact your veterinary hospital to make them aware of the occurrence of the seizure. Blood levels of the medication may need to be monitored and/or the medication may need to be increased. Alternatively, sometimes new medications may also be added to help control the seizure activity. It should be remembered that for some conditions, you will need to administer daily medications for the life of your pet to control his/her seizures. If you stop the treatment abruptly, even just because you ran out of the medication for a day or two, severe seizures might occur.

Some pets can have their seizures triggered by certain events or circumstances, and you may find that a pattern emerges where seizures occur at a particular time. If this is the case, you should consider eliminating these triggers—such as certain activities—if possible.

Frequently Asked Questions

Why do I need to time my pet’s seizure?

It is important to time the seizure because seizures that last for more than 5 minutes can raise the body temperature and should be terminated with medication given by injection (veterinarian) or rectally (by you, if medication has been prescribed for this purpose).

Why is it important to keep track of seizures in a log?

After a series of seizures, some pet owners can forget when and for how long the seizures occurred. By reviewing your journal log of seizure activity, your veterinarian can better determine a treatment protocol for your pet.

Do seizures cause permanent damage?

Uncontrolled seizure activity that lasts for more than 5 minutes does risk causing hyperthermia. This is the reason ongoing seizure activity warrants an immediate visit to a veterinary facility for treatment, or treatment by you if your veterinarian has prescribed it previously (rectal diazepam/Valium, for example). Hyperthermia can cause brain damage if it is severe and ongoing. Seizures themselves may also favor more seizures occurring in the future, and for this reason, daily oral antiseizure medications are warranted if the seizures are occurring frequently. This should be an important point of discussion with your veterinarian.

Are seizures painful?

No, the exact same types of seizures that occur in humans and animals are not described as painful by humans who can tell us how it feels. The sensation is of an impending seizure (aura), then the seizure itself (during which the animal is unconscious), and then the postictal, or recovery, phase in which the animal regains consciousness. It is not a painful process unless movement or thrashing causes injury, and preventing this is an important way you can help during the seizure (see above).

What if my pet has a seizure when I’m not home?

It is important to modify the home environment in anticipation of seizures occurring during the day if no one is home. Ways of doing this can include installing baby gates at the top of stairs so a pet is confined to one floor of the home (and cannot fall down the stairs when a seizure occurs); moving or bracing furniture and objects that could fall or break if struck by the legs during a seizure; and quickly assessing the home before leaving for the day or when arriving home to be able to notice changes such as spills or objects that have moved as evidence of a seizure having occurred.

Background

In dogs and cats, like in people, diabetes mellitus is a lack of insulin (or inadequate effect of insulin) in the body. The treatment for diabetes, therefore, is to give insulin. One of the easiest ways to ensure successful at-home treatment of a pet that has diabetes is to become comfortable handling and delivering insulin by simple injection.

Insulin injections are not painful because they are not deep (only skin deep) and the needle is very thin: 1/80th of an inch in diameter [0.31 mm], only slightly thicker than a human hair. Most dogs and cats don’t even feel them. The key is simply to become comfortable giving the insulin and doing it as part of a daily routine, because consistent and effective insulin administration is lifesaving.

Insulin injections have to be given daily (twice a day in most cases: once in the morning and once at night), and your veterinarian will specify how much to give and whether to give it once or twice a day.

Several types of insulin are available, and they differ from each other in several important ways, including how long they work. This in turn directly affects how often they must be given.

Different types of insulin are formulated in one of two different concentrations. Insulin will either be “U 40 insulin,” in which 1 cc contains 40 units of insulin (1 cc = 1 mL, or milliliter), or “U 100 insulin,” in which 1 cc contains 100 units of insulin. Being aware of the concentration of insulin that is being used to treat a pet is paramount: it helps you avoid overdosing or underdosing and will ensure that the correct corresponding insulin syringe is also being used.

Insulin is a fragile substance that can lose its activity if it is not treated well. Keeping the insulin intact is important so that the injections retain their antidiabetic effect:

Always keep insulin refrigerated but never frozen. This may require using a cool pack to bring the insulin home from the veterinary clinic on hot summer days, for example, and making sure that where you store it in your refrigerator and the refrigerator’s settings do not cause freezing.
Be sure to handle the insulin bottle fairly gently. Vigorous shaking can damage some types of insulin and inactivate it.

Getting Started

The only supplies needed are the insulin bottle, the insulin syringes, and a container for disposing of the used syringes. Because the needles for administering insulin are extremely thin, giving insulin should be quick and easy for both you and your pet. If, however, there is any hesitancy about placing the needle correctly into the skin, be sure to have a veterinarian or veterinary technician review it with you and demonstrate until it feels like a straightforward thing to do. In very furry pets, it might be helpful to have a small patch of hair shaved between the shoulder blades to allow for easier placement of the needle into the skin. A simple mistake to be avoided in pets with very thick haircoats is to not have the needle even enter the skin, meaning that the insulin is accidentally just squirted onto the skin. This is of no benefit and means the pet did not receive insulin for that dose.

Troubleshooting Beforehand

If your veterinarian has changed your pet’s insulin type, be sure the concentration of the insulin hasn’t changed (U 40 versus U 100). This is always written on the bottle. When the concentration of insulin has changed, the syringe required to draw up an accurate dose will change as well because the insulin syringes are purpose-made (graded) for a given insulin concentration. If the concentration of the insulin has changed, all remaining unused insulin syringes must be discarded to avoid accidental over- or underdosage.

Insulin can be damaged in several ways, all of which must be avoided. If any of the following occurs, the insulin bottle should be discarded immediately and replaced:

The insulin has been heated (left for 6 hours at room temperature [or less than 6 hours if warmer]).
The insulin reaches freezing temperatures.
The bottle has been shaken or dropped on the ground, unless it is of a type meant to be shaken (e.g., Vetsulin, Caninsulin).
The insulin appears stringy or has clumps in it.
The insulin has changed color (normally it should be clear like water at first and very slightly hazy gray when suspended/gently agitated for administration).

Expect to use a new syringe and needle every time insulin is administered. This will ensure that the needle is both clean and sharp and will minimize the chance for contamination of the insulin.

Procedure for Administering Insulin Injections

Bring your pet and the supplies into a comfortable area. Use a calm tone of voice and reassuring body language, and help him/her feel relaxed. A cat or small dog may be comfortable on your lap or on a table in front of you. A larger dog will do well sitting or standing on the floor.

Then, practice “tenting” the skin behind the neck between the shoulder blades. This means pulling up some skin (approximately a half inch to an inch [1-2 cm] elevation is usually fine) between your left thumb and index finger if you are right-handed. This creates a triangular tent shape in the skin that lies behind the neck. This should be completely comfortable to your pet; if it isn’t, you should try a different area of the body, such as the shoulder or the lower back (area on the back a few inches ahead of the tail). If you are right-handed, it will be easiest to tent the skin with your left hand and hold the syringe with your right hand. Practice holding an empty syringe with your dominant hand first (for example, your right hand if you are right-handed), and handle your pet with the other hand. You should be holding the syringe like a pen: first three fingers (including thumb) all bunched together holding the body of the syringe halfway down the length of the syringe, like holding a pen halfway down the length of the pen when writing. Do not place your thumb on the plunger yet (a common mistake).

To start, take the insulin bottle from the refrigerator, and gently roll it between two hands for 30-60 seconds, and then invert it slowly and back again several times (note: Vetsulin/Caninsulin type insulin is an exception to the rule, and is shaken to mix). This serves to suspend the insulin uniformly in the solution in the bottle, because insulin gradually settles to the bottom of the bottle when it sits undisturbed for several hours.

A new insulin bottle will have either a metal tab or plastic lid covering the rubberized top. Remove this prior to first use. The rubberized membrane that is exposed this way (usually gray or orange) is the point for inserting the needle into the bottle.

Take a new insulin syringe, remove the syringe cap (typically orange plastic), and insert the needle into the rubberized top. At the second use of the bottle, use an alcohol wipe (available at any pharmacy, or you can use a cotton ball wetted with alcohol) to quickly clean the rubber top, allowing it to air dry. Invert the bottle such that the bottom of the bottle is pointing at the ceiling. With the needle still inserted in the bottle, draw back on the syringe plunger. Visualize the clear liquid insulin entering the syringe. Should any bubbles enter the syringe, gently tap the syringe until they rise up, and then you can inject them back into the bottle. When you have drawn up the desired volume of insulin, withdraw the needle from the bottle. Some people draw back more than is necessary and then, before withdrawing the needle, push the extra amount back in the vial to be left with the exact correct dose; this is helpful for expelling air bubbles. Others prefer simply to draw up the correct dose right from the start. Any approach is acceptable as long as you are left with the correct dose in the syringe, and no air bubbles, before you withdraw it from the bottle.

Now, to give the insulin, create the skin tent with your nondominant (e.g., left) hand. Hold the syringe with the insulin in it in your other hand the same way you would hold a pen or pencil. Do not place your thumb on the plunger, as this may cause you to expel the insulin before the needle is in place. Direct the needle into the empty space under the skin created by the tent (the “inside” or “base” of the tent). In the process, be sure to avoid stabbing your own fingers holding the skin tent. Because of the thinness of the needle, you will not feel it go in (nor should your pet). Therefore, advance the needle all the way in, until the hub (plastic) of the syringe is against the skin. Now you can move the thumb of your right hand (holding the syringe like a pen) to the plunger. This means that you gently shift your hold on the syringe from holding it like a pen (three fingers) to holding it like a cigarette between your index and middle fingers. With your thumb, depress the plunger to deliver the insulin. At first this takes time, but with practice, the time from lifting the skin tent to giving the insulin and being finished is typically less than 10 seconds.

Afterwards

A rigid plastic receptacle for used insulin syringes is helpful (e.g., an empty bleach or laundry detergent bottle). Syringes and needles should be stored safely away from children and pets. Used syringes and needles can often be returned to your veterinary hospital for disposal, and you should check with your veterinarian regarding laws that govern the disposal of medical sharps in your area.

It is wise to demonstrate your technique (and give an injection of saline instead of insulin as a demonstration to your veterinarian) at the time of recheck, because this helps your veterinarian identify and fix problems with insulin administration. This demonstration, to make sure technique is working well, is one of the simplest and most effective actions to take for optimal treatment of diabetes.

Frequently Asked Questions

What if I can’t read the numbers on the syringe to draw up the tiny volume of insulin my veterinarian prescribed?

An insulin pen might be the perfect solution. These devices are loaded with several days’ worth of insulin and can be reloaded when that runs out. Instead of drawing up the right amount of insulin into a syringe, you set a dial on the pen to the desired volume of insulin to inject. You then simply hold the pen to your pet’s skin, and press a button. The insulin is quickly injected through a tiny needle. Your pen is ready to be used again when needed, with only occasional refills of the insulin. The only real downside of these pens is that they are more expensive than using a needle and syringe, and pens are not available for every insulin type.

I left the insulin out of the refrigerator by accident. Is it still good?

Insulin can stay at room temperature (70°F [18°C]) for up to 6 hours, but some types begin to lose potency quickly. If insulin has been left out at this temperature only once for less than 6 hours, it can continue to be used. If it has been left out for longer than 6 hours cumulatively, it should be discarded and replaced.

Are there alternatives to insulin, especially oral medications?

Yes and no. Oral antidiabetic drugs that are commonly used in diabetic people have been tried in pets and are of limited benefit. Fewer than 1% of dogs show any improvement (and the rest worsen), whereas some 20% of cats may improve with oral treatment instead of insulin but generally only for a period of a few months. Then the oral medications lose their efficacy, and insulin becomes necessary anyway. Therefore, insulin remains the treatment of choice for diabetes.

Can dogs and cats go into a diabetic coma, like people?

Yes. Untreated diabetes can deteriorate to diabetic ketoacidosis, a severe state that ultimately can lead to diabetic coma if not treated promptly. The goals of treating diabetes are both to eliminate symptoms (restoring a healthy state of being) and to reduce the risk of such complications.

Do diabetic dogs and cats have circulatory problems in their legs, like people?

No, fortunately this is almost unheard of in dogs and cats, unlike in people.

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Background

Getting Started

Troubleshooting Beforehand

Procedure

Afterwards

Frequently Asked Questions

Background

Getting Started

Troubleshooting Beforehand

Procedure for Postoperative Home Care

Afterwards

Frequently Asked Questions

Background

Getting Started

Troubleshooting Beforehand

Procedure: How to Perform the Exercises

Forelimbs (Front Legs)

Hindlimbs (Hind Legs, Back Legs)

Afterwards

Frequently Asked Questions

Background

Getting Started

Troubleshooting Beforehand

Procedure

Afterwards

Frequently Asked Questions

Background

Getting Started

Troubleshooting Beforehand

Procedure

Color

Swelling

Discharge

Afterwards

Frequently Asked Questions

Background

Troubleshooting Beforehand

Procedure

Afterwards

Frequently Asked Questions

Background

Getting Started

Troubleshooting Beforehand

Procedure for Administering Insulin Injections

Afterwards

Frequently Asked Questions

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