Background

Aggression is a normal form of communication for animals and a common life-threatening behavior problem in pets. The problem is not only dangerous for humans or other animals to which the aggression is directed, but left unresolved, aggression is a common reason for pets to be euthanized.

Staring, growling, hissing, lunging, snapping, swatting, and biting are all behaviors described as aggression. Many conflicting opinions and misinformation can be found online, on television, and in books describing the motivations behind aggressive behaviors. However, scientific research tells us that fear, anxiety, and pain are often the most common reasons why animals will use aggression.

Getting Started

When an animal first shows aggression, a thorough physical exam, neurologic exam, and orthopedic exam by a veterinarian will help to rule out underlying medical conditions that may be stimulating the aggressive behavior. A complete blood count, serum biochemistry profile, and urinalysis help to evaluate organ function along with a thyroid profile if supported by other findings, to rule out hypothyroidism in dogs and hyperthyroidism in cats.

Troubleshooting Beforehand

Safety is a top priority when living with or working with aggressive animals. Identifying and avoiding the triggers for aggression when possible will reduce the opportunity to practice the behaviors and help your pet feel safe. Recognizing body language cues of fear, anxiety, and stress such as ears back and flat against the head, head down, tail tucked, lips tight and drawn back, leaning away or crouched position, avoiding direct eye contact, licking of the lips, yawning, dilated pupils, and hair standing up (piloerection) will help to increase safety when you recognize these and indicators of a potential aggression response from your pet. Many people are under the misimpression that a dog wagging its tail is happy; this is not true. Tail wagging actually signals a willingness of the dog to interact, be that through happy interactions like play or petting, or in the case of an aggressive animal, through biting.

Procedure

Treating aggression can be challenging, and often these animals are not cured, but rather managed; it all depends on the underlying motivation.

The procedures below can be helpful, but they do not replace expert help for an individual animal. Contact your veterinarian for referral either to a trained veterinary behaviorist, or to a reputable animal trainer. This is important because many so-called trainers are not actually equipped to help, and some recommendations can be counterproductive.
The first step of treatment often involves increasing human safety by teaching the dog to wear a basket muzzle (Baskerville or Italian Basket Muzzle; see Figures 1 and 2). If desensitized and counter conditioned properly, dogs can learn to love wearing a muzzle. Some will even ask to put it on. The openness of the basket helps to reduce severity of bites and allows delivery of treats during training and behavior modification sessions.
Identifying potential triggers and avoiding them or the use of desensitizing and counterconditioning to reduce fear associated with these triggers can also be of value.
Dogs and cats can react to a variety of different triggers such as other dogs, other cats, certain people, children, noises, bicycles, cars, and situations. For the dog that is aggressive to visitors, putting the dog away in a crate or behind a closed door with a yummy treat such as a food-stuffed Kong or puzzle toy will help remove the dog from situations that make him or her uncomfortable. The long-lasting treat or toy helps to condition the dog to form more pleasurable or positive associations with visitors.
For dogs and cats aggressive to other cats in the household, separation is key to managing and reducing aggression.
For dogs that are aggressive to other dogs on and off leash, avoiding dog parks or walking the dog in a location where other dogs are rarely present may be required. Teaching the dog to “look” or “watch” you (eye contact) instead of the other dog or person on walks will help to redirect the dog and when paired with yummy treats, form more positive associations with these triggers.
Tools such as head collars and front clip harnesses give you better control of your dog on walks and help redirect your dog’s focus away from the trigger as he or she continues to move on past. These can also be used in the house attached to a 6- or 4-foot (2- or 1.3-meter) leash if needed for extra safety. Retractable leashes should never be used with an aggressive dog of any size: they provide no control and can be scary if dropped or snapped.
For cats and dogs, positive reinforcement training is excellent for improving communication and teaching behaviors used for redirection in a nonconfrontational way.
In the house, dogs and cats can be taught to stay on a mat for various periods of time. This mat is a very useful place to redirect your pet if you notice behaviors indicating an impending fight between household pets or if your pet needs to be safely removed from the couch, chair, or bed without confrontation.

Afterwards

Punishment in the form of shock collars, water bottles, cans of pennies, alpha rolls, spanking, or even just yelling “no” is often counterproductive with aggression. It is much more effective to teach and reward your pet for acceptable behavior than it is punishing the ones you do not desire. The use of corrections can confuse and frustrate dogs and cats, making them more fearful or anxious and increasing the likelihood that they will bite.

As with other behaviors, early detection and intervention are crucial in the management and treatment of aggression. Early socialization along with fun and pleasurable interactions with humans and other animals will help dogs and cats experience less fear or anxiety when presented with novel stimuli in their environment. It gives them the opportunity to form better coping skills.

Basket muzzle seen from the dog’s perspective. The open spaces allow breathing and make the muzzle comfortable.

Basket muzzle being placed on a dog. Note the open spaces that allow the tongue to pass through and receive a treat.

Frequently Asked Questions

Are medications available to modify my pet’s aggression?

Medications are available to modify some behaviors and should be used only in conjunction with a complete behavior modification program under the direction of a veterinarian. Contact your veterinarian for further guidance.

Can my pet’s aggression become worse over time?

Yes. This is why it is important to identify triggers that, without your knowledge, may be triggering aggression. By managing your pet’s environment and preventing exposure to triggers, aggression is less likely to occur.

Is there ever a time when a repeatedly aggressive dog or cat can be considered cured of his/her aggression?

Unfortunately, an animal that is aggressive is never considered cured. However, with proper management, safety improves for all involved. Early intervention and an understanding of body language cues reduces the risk of human injury or self-injury.

What are the circumstances where a simple punishment should help to correct aggressive behavior?

None. Research shows us that punishment is likely to increase fear, anxiety, and aggression.

Author

Christine D. Calder, DVM, DACVB

Background

Veterinarians routinely prescribe medications, either in a liquid oral form or a tablet form. With either one, the goal is for your pet to receive the medication as easily as possible in your home. It is important that you give your pet the medication as directed by your veterinarian and for the entire time prescribed. Many health conditions may not improve without proper medication.

Terminology: “oral liquid” and “oral syrup” are interchangeable terms, but “pill” and “tablet,” strictly speaking, are not. A pill is perfectly round (spherical), and virtually no medications are made this way anymore because they can roll into awkward locations or be lost altogether when accidentally dropped. Tablets are round in one dimension and flattened/biconvex in the other, a familiar shape for medications in both human and veterinary medicine. They may be circular (most common), oval, or even triangular in shape. Capsules are hollow, closed-ended tubes that contain the medication in powdered or granular form.

Getting Started

Equipment/materials needed for oral liquid medication:

Medication
Syringe (if liquid)

Equipment/materials needed for tablet or capsule medication:

Tablet splitter (if each dose is less than a full tablet)
Food or “Pill Pocket”
A syringe with 3 to 5 mL of water

Troubleshooting Beforehand

If is usually acceptable to give pills or capsules hidden inside a small bite of food, even if the medication is to be given on an otherwise empty stomach. Most dogs will take medication hidden in a small piece of food such as cheese, peanut butter, or canned dog food. There are also commercially available treats with a hollow center specifically meant to hold tablets or capsules (e.g., Pill Pockets®). Some dogs may find the tablet and spit it out. Cats often are much more clever (or discriminating): they can smell the medication and will often not take it in food.

If your pet shows resentment to receiving medications this way, stop the procedure and call your veterinarian for further advice. There may be other treatment alternatives, such as compounding, where the medication is transformed into a meat- or fish-flavored syrup or chewable tablet that most animals will take willingly. Do not cause risk to the health of your pet (no veterinarian likes to hear “It takes three of us and a wrestling match, but we’re getting the medication in,” because the stress may cause serious harm to the pet). Do not put yourself in harm’s way or allow yourself to get bitten.

Always give your pet water to drink or a small amount of food to eat after the tablet has been given (a “chaser”). This helps ensure that the medication will travel to the stomach. Without doing this, some medications will get stuck partway down the throat and can cause sores as the medication sits and dissolves against the wall of the esophagus. If your pet won’t willingly drink or eat, you can use a syringe to give a small volume (3 to 5 mL) of tap water, as described below for liquid medication.

If your pet has vomiting or diarrhea after medication administration, or what you feel may be an intolerance to the medication or other adverse effect, call your veterinarian. The medication your pet is receiving may have to be changed.

Procedure

Oral Liquid

Fill the oral syringe or bulb with the desired amount of medication. Usually, there is a special top on the liquid bottle that allows you to easily attach a syringe. Once attached, hold the bottle upside down and draw out the liquid into the syringe. Some liquids are very thick and sticky, others are watery. You can draw more than you need, then squirt the extra back in the bottle. Look to be sure you have the right volume of liquid without any large air bubbles. Once you have the syringe filled to the right amount, turn the bottle back over, remove the syringe, and recap the bottle.
Allow your pet to keep his/her mouth closed throughout this process.
Insert the tip of the oral syringe into the corner of the lips on either side of the mouth. It is not necessary or desired for the mouth to be open.
Hold the head pointing slightly upward (chin elevated), and squeeze the plunger gently to administer the medication into the cheek pouch over a period of 3 to 5 seconds. Often this is accompanied by licking movements of the tongue as the pet swallows the medication.
Keeping the head elevated (lift the pet’s chin) helps ensure that the medication trickles to the back of the mouth and is swallowed, not dribbled out the front of the mouth.
The cheek pouch approach is preferred over prying the mouth open and squirting the medication into the back of the mouth, because keeping the mouth closed is more comfortable to the pet, and it is less likely that a vigorous squirt will hit the back of the throat, causing gagging or coughing.
Instead of this approach, you may try placing a small amount of medication on the food and see if the pet will eat it. This should be done just as an attempt, because some pets will not eat food that has medication sprinkled on top.

Tablet

If the medication must be cut in half, place the tablet in a tablet splitter (available at your local pharmacy) and cut directly in half. Place half of the tablet back into the medication vial.
For dogs, try placing the medication in a small piece of cheese, peanut butter, or canned food. Give the dog a piece of food that does not have the medication in it. Next, give the food with the medication in it, followed by another non-medicated piece. Ensure your dog did not spit out the tablet and that it is not caught in the lips.
Tablets may also be placed in Pill Pockets, a hollow, semimoist treat designed to hold medication. Be sure, if you are using these or a treat (cheese, peanut butter, other), that your hand that touches the tablet does not touch the treat. Some dogs and many cats have a sufficiently sensitive sense of smell that they will detect the smell of medication on the outside of the treat that came from you touching the outside of the treat with powder or residue from the tablet.
For dogs that will not take the medication in food, place one hand on the top of your pet’s nose/mouth (your right hand if right-handed). With the other hand, open the mouth and place the tablet on the farthest point of the back of the tongue using your index finger. Quickly remove your hand; shut the mouth and hold closed. Gently squirt a 5- to 20-mL (1 to 4 teaspoons) syringe of water into the cheek pouch (as described above for liquid medications) to encourage the pet to swallow. You may also rub your pet’s throat to encourage him/her to swallow. Again, check the mouth, lips, and floor to ensure your pet has swallowed the tablet and not spit it out.
For cats, begin by “administering” a treat that the cat likes very much, like a small amount of canned tuna. Take a small pinch of tuna between your left thumb and forefinger, and place your right hand behind your cat’s head, using the thumb and forefinger of your right hand to stabilize the upper jaw. With your left hand, open the mouth and place the tuna on the farthest point at the back of the tongue with your index finger. Quickly remove your hand. Cats quickly understand that this type of handling equals tasty treats (like tuna), so repeat this once or twice with tuna, then administer the medication tablet or capsule in the same way, then once more with tuna. Afterward, you can gently squirt a 5-mL (1-teaspoon) syringe of water into the cheek pouch, encouraging your cat to swallow. You may also rub your cat’s throat to encourage him/her to swallow.
Pill Poppers may also be used to aid in the medicating of pets as a last resort. Pill Poppers are a thin, rigid tube that contains a plunger (to be pressed by your thumb) and a rubber tablet holder at the tip. To use a Pill Popper, begin by placing the medication in the rubber tablet holder at the tip. You should then hold your pet’s head as described above. Insert the Pill Popper into the mouth, directly toward the back of the tongue. By depressing the plunger with your thumb, the tablet will pop out of the rubber holder and into the back of the throat, where it is swallowed. Be sure to follow the tablet with a syringe full of water as described above, ensuring the medication is swallowed.
Some kinds of medications may also be crushed and sprinkled on top of food, if needed. (This should be the last method used; many pets will not eat food that has medication sprinkled on top.) To crush a tablet, you can use a mortar and pestle or place it between two spoons and apply pressure to break it into small fragments and powder. Alternatively, pharmacies also sell handheld tablet crushers. Not all medications should be crushed – be sure to ask your veterinarian or a pharmacist before trying this method.

Afterwards

Pets are clever and many times they do not understand that medications are intended to help them. Often, pets find a way to avoid taking medication. If they do, you must change the method used to medicate your pet, ensuring he/she is receiving the entire dose.

Your veterinarian may request to see your pet for a recheck during treatment or once the medication has been finished. You should call and schedule your appointment, and be sure to bring the medication with you to confirm that what you are giving and what the veterinarian thinks you are giving are the same thing. If the medication is to be given long term, remember to request refills in plenty of time so that you do not run out of the medication.

Always keep medication out of the reach of children. Ensure that all caps or lids are closed well, and wash your hands after you administer the medication.

Frequently Asked Questions

What if I cannot medicate my pet?

It is very important that your pet receives the medication as directed. If you cannot give the medication, call your veterinarian. Your hospital may help you medicate your pet or may change medications.

Should I feed my pet when I give the medication?

Some medications should be given with food; others should not. Ask your veterinarian what is best when you receive the prescription.

Should I wear gloves to medicate my pet?

Most medications are safe and can be administered without protection; however, gloves must be worn with some medications. Ask your veterinarian if you should wear gloves with your pet’s prescription.

How should a liquid medication be stored?

Many liquid medications should be stored in the refrigerator, at least after water is added to a powder to make a solution. Make sure you know the proper storage conditions for each medication

Oral syringe (in right hand) is slipped into the cheek pouch at the corner of the dog’s lips, while the head is held slightly elevated (left hand).

Placing medication (or tuna or other tasty treat) in a cat’s mouth. The right hand is holding the upper jaw while the left hand is both pushing the lower jaw down (opening the mouth) and dropping the treat or medication into the mouth (thumb and index finger).

Background

Ear medications are often administered to pets that have an ear infection, inflammation, or a condition within the ear canal that requires treatment. It is important to treat the ear canal correctly, ensuring the solution reaches the target location. With practice, instilling medications into the ear canal is easy and can be done at home as needed.

Getting Started

Equipment/materials needed:

Gloves
Topical ear medication

Your veterinarian should have prescribed a specific medication to administer into your pet’s ear. You should wear latex (or similar) medical exam gloves to prevent you from coming in contact with potential bacteria or fungi that your pet may harbor, as well as with the medication.

Troubleshooting Beforehand

The ear that is affected should begin healing within the first few days of medication application. In serious conditions, healing may take longer. However, if you notice any of the following symptoms, you should contact your veterinarian immediately:

Increased discharge
Increased redness, swelling, or heat from the ear
Increased pain
Increased shaking or scratching of the head
Spreading of the condition
Inability to instill the medication (for example, if your pet will not allow it or because you feel you are not doing it correctly)

If your pet shows resentment to having this done, stop the procedure and call your veterinarian for further advice. The ear may be too painful to treat without additional medications, and it is imperative that you neither hurt your pet nor put yourself at risk of a nip or bite. Resistance to treatment may also be an indication that an infection is worsening and needs to be rechecked immediately.

Procedure

In calm pets, medications can be administered into the ears by just one person, but with young, excited animals or pets that dislike (or are unfamiliar with) having the ears handled, it may be necessary to have one person distracting and/or holding the pet while another person instills the medication. Whatever motivates your pet can serve as a distraction – a bit of food, a ball (just the sight of the ball can distract many dogs!), etc. The whole process should take less than 5 minutes. If it is too complicated or difficult, notify your veterinarian to discuss whether there are alternative strategies.
If your veterinarian provided you with a solution to clean the ears, this must be done before instilling medication. This allows ear debris to be loosened before the application of the medication, and if the medication were placed first, before the ear cleaning, the cleaning solution would eliminate the medication altogether.
With one hand, gently flip the ear flap straight up. This is best done by cupping the ear flap (pinna) in your right hand, with the haired part of the ear against the palm of your hand and your thumb on the hairless inner surface of the ear flap. You should be able to see the inside of the ear (ear canal) this way. Some breeds of dogs have naturally upright ears, and in these dogs, the hand can simply be cupped behind the ear.
Holding the ear flap cupped in the palm of your hand means that the ear canal takes on the shape of a funnel. You can then drip the medication directly into the deepest part of the ear canal. Be sure not to put the tip of the nozzle (or medication tube) directly into the ear canal. Rather, place the tip of the tube or bottle at the opening of the ear canal, and aim the nozzle so the drops of medication fall into the greatest depth of the ear canal. Do not allow the nozzle tip to touch the ear canal, which would contaminate the bottle/tube and its contents. Massage the entire canal by using your thumb and forefinger to gently roll the tissues of the ear canal. It feels like a tube under the skin and may be painful in some dogs—do this gently, and stop if there are signs of pain like crying or pulling away, allowing the medication to work through the entire ear.
All dogs will shake their head after this, which propels the wax and debris outward and away from the eardrum. You can wipe this off the inner surface of the ear flap with cotton gauze. This is why Q-tips and other cotton swabs should NEVER be inserted in the ear canal: they push debris further in, whereas ear cleaning loosens the debris so it can be expelled.
If your pet scratches his or her ear excessively, an Elizabethan collar (E-collar) may be necessary while the medication is taking effect. These collars can be purchased from your veterinarian or a pet supply store. Scratching the ears can cause self-induced damage and therefore must be prevented.
Remember that the medication is cooler than body temperature and may feel cold to your pet when you apply it in the ear, especially on raw or sensitive areas. Apply a small amount at first, allowing the pet to become comfortable and adapt to this type of treatment, or warm the cleaning solution or medication by holding the tube or bottle in your armpit for 15 minutes before administration. The comfort that the medication brings makes it worthwhile.

Afterwards

Once you have finished, discard any remaining used gauze and gloves. Replace the cap on the medication and place in a safe area, out of reach of children and pets.

Frequently Asked Questions

How often do I need to clean the area and apply the medication?

Your veterinarian will direct you regarding how often to clean your pet’s ears and apply the medication, based on the seriousness of the ear problem and how good a response is seen from initial treatment. It can vary from twice a day (certain medications) to once a week (light cleaning), and from a short course to lifelong, depending on the tendency of the problem to recur.

Should I apply the medication only until the area of concern is healed?

Cleaning and medication application should be performed for as long as the veterinarian recommends, because some lesions or infections may appear healed, when in actuality the healing is incomplete. Some types of conditions take much longer to heal than others. An important exception is if you feel the condition is worsening during/despite treatment, and if you have any question in this respect, you should contact your veterinarian.

Are there any restrictions for my pet during treatment for an ear problem?

Your pet should not have a bath or play in water until the area of concern has healed. Your veterinarian should recheck your pet’s condition and advise you when your pet can have a bath and go swimming.

Can my pet cause more damage if he/she continuously shakes or scratches at the head?

Yes, your pet can cause more damage (such as the appearance of an ear hematoma) and may require surgery should the condition worsen. An Elizabethan collar may be applied to prevent scratching of the ears as a temporary solution while medications begin to take effect. Contact your veterinarian if your pet continues to shake his or her head despite treatment.

BACKGROUND

Ear infections are common in pets, and an important way to help eliminate these infections is to clean the ears. It is important to treat the ear canal correctly, ensuring the solution reaches the target location. With practice, instilling solutions into the ear canal is easy and can be done at home as needed.

GETTING STARTED

Equipment/materials needed:• Gloves• Cotton balls or gauze• Ear-cleaning solution Your veterinarian may have prescribed a solution to place in your pet’s ear. You should wear latex (or similar) medical exam gloves to prevent you from coming in contact with potential bacteria or fungi your pet may harbor. Basic hygiene is important, and you should be sure to wash your hands immediately after each ear-cleaning session.

Choose a location where expulsion of contents from the ear canal, which is going to happen at the end of the procedure with headshaking, won’t cause a messy problem (i.e., don’t do this with your pet beside something that is valuable and difficult to clean).

TROUBLESHOOTING BEFOREHAND

Ear-cleaning solutions are generally applied to maintain your pet’s ear canals and prevent infection. However, if you notice any of the following symptoms, you should contact your veterinarian immediately:

Increased fluid or pasty discharge from one or both ears• Increased redness, swelling, or heat from the ear
Increased pain
Increased shaking or scratching of the ears
Inability to instill the solution (for example, if your pet will not allow it or because you feel you are not doing it correctly)If your pet shows resentment to having this done, stop the procedure and call your veterinarian for further advice. The ear may be too painful to treat without additional medications, and it is imperative that you not hurt your pet or put yourself at risk of a nip or bite. This may also be an indication that the condition is worsening and should be checked immediately.

Keep in mind that some individuals are more prone to ear disease than others. This can be due to ear shape (floppy-eared dogs are especially susceptible), environment and activity (swimming allows water in the ears and favors infection), and likely genetic predisposition as well. Therefore, ear cleaning should be done when your individual dog or cat needs it, which is different from one individual to the next. Be sure to ask your veterinarian about the best interval between ear cleanings to avoid over- or underdoing it. Excessive ear cleaning must be avoided because it causes inflammation in the ear canal, which is totally counter productive.

Never use Q-Tips or other cotton-tipped swabs to clean your pet’s ears. Too often, this results in pushing the debris back into the ear canal, which is the opposite of the intended effect. Cotton balls or gauze squares work well to remove debris from the ear flap and upper ear canal.

A really helpful preparatory step is to put the bottle of ear-cleaning solution under your own armpit for 10 or 15 minutes before the ear cleaning. This brings the solution to body temperature and makes it much more comfortable and pleasant for your pet.

PROCEDURE

In calm pets, ear cleaning can be done with just one person, but with young, excited animals, or pets that dislike (or are unfamiliar with) ear cleaning, it may be necessary to have one person distracting and/or holding the pet while another person instills the solution. The whole process should take about 5 minutes. If it is too complicated or difficult, notify your veterinarian to discuss whether there are alternative strategies.• With one hand, gently flip the ear flap straight up. This is best done by cupping the ear flap (pinna) in your hand, with the haired part of the ear against the palm of your hand and your thumb on the hairless inner surface of the ear flap (see right hand in

Correct way to place cleaning solution in the ear. For the dog’s left ear as shown, your right hand holds the pinna (ear flap) upward, and your left hand places the nozzle of the bottle at the entrance to the ear canal.

After the cleaning solution has been placed in the ear canal, use your right hand to gently massage the outer part of the ear canal. It is just forward of the ear opening (shown where the right thumb is, here).

first photo, below). You should be able to see the inside of the ear (ear canal) this way. Some breeds of dogs have naturally upright ears, and in these dogs, the hand can simply be cupped behind the ear.

Holding the ear flap cupped in the palm of your hand means that the ear canal takes on the shape of a funnel. You can then place the lukewarm cleansing solution into the ear canal, allowing the solution to fill the canal to the brim. This means a gentle stream of the solution will need to go in for several seconds, not just a few drops. In a medium-size dog, 1 tablespoon (15 mL) typically will be necessary; a half to 1 teaspoon (2.5 to 5 mL) is expected for cats. Do not allow the bottle tip to touch the ear canal, which would contaminate the bottle and its contents.
Then lower the ear flap and massage the ear canal for 1 minute. Do this by using your thumb and forefinger to gently compress and roll the tube-shaped ear canal. You can feel it through the skin and hair at the base of the ear, directed inward and slightly toward the dog or cat’s hind end.
Having placed the cleaning solution in the ear and done the ear massaging, now allow your pet to shake his or her head. This will loosen debris in the ear canal and propel it outward. Then use a cotton ball to clean the ear flap and upper ear canal.

AFTERWARDS
Once you have finished cleaning the ears, discard any remaining used gauze and gloves. Replace the cap on the cleaning solution, and place it in a safe area out of reach of children and pets.

FREQUENTLY ASKED QUESTIONS

My dog/cat really doesn’t like ear cleanings. What do I do?
Often, making sure the ear-cleaning solution is at body temperature (using the armpit technique described above) is all that is needed for making the process much more comfortable and therefore acceptable to a pet. Also, be sure to offer him or her a special treat when you are finished, every time, to make it something he or she looks forward to. If resentment and resistance persist, contact your veterinarian, because a short course of oral medications or an injection of medication may reduce much of the inflammation and pain that cause a patient to resist ear cleaning.

How often do I need to clean the ears?
This will depend on the individual pet and any conditions being treated. Your veterinarian will direct you how often to clean your pet’s ears. It is important that you follow the directions given, because some pets require frequent ear cleanings and others much less so.

Can my pet cause more damage if he continuously shakes or scratches his head?
Yes, your pet can cause more damage to his or her own ears through scratching and headshaking. In such situations, an Elizabethan collar (E-collar) may be necessary temporarily to prevent scratching of the ears and serious self-induced trauma while ear medication takes effect. Contact your veterinarian if your pet continues to shake his/her head or scratch constantly at the ears.

The ears look redder after I clean them than before. What do I do?
This is common and expected with some liquid ear solutions and should subside quickly (typically a day or less) afterwards. If you find that the ears are staying much redder than before, be sure to contact your veterinarian to discuss an alternative treatment (or assess whether the ear problem is itself responsible for these changes).

BACKGROUND

Brushing your pet’s teeth is the key to maintaining good oral hygiene. As a result, dental cleaning procedures at your veterinarian are less likely to be simpler (meaning shorter anesthesia time, fewer pulled teeth, etc), your pet’s health may be improved overall, and bad breath (halitosis) is reduced.

Brushing the teeth also helps spare a dog or cat oral pain: periodontal disease, a painful condition that occurs when inflammation affects the gums and other tissues around the teeth, is reduced or eliminated with good oral hygiene. Brushing the teeth is not difficult, and most pets will accept the procedure with a little patience on your part. Primarily, you only need to focus on brushing upper teeth (not the lower teeth), and only the outside surfaces of the teeth (not the inside surfaces).In dogs and cats, like in people, what the dentist and hygienist do is only a small, though essential, part of the oral hygiene program. The responsibility for health and general well-being of your dog or cat is yours, and this should include basic dental care. Brushing your pet’s teeth is the main component of home dental care.

The purpose is to remove plaque before it becomes tartar. Plaque is a slime composed of bacteria, saliva, and food particles that adheres to the teeth and fills the pocket between the tooth and gum. Left undisturbed, plaque rapidly collects minerals from the saliva to form the rock-like brown deposits known as dental tartar. Dental tartar cannot be removed by any amount of brushing. By brushing your pet’s teeth daily, you remove plaque, preventing or slowing tartar buildup. Results depend on the effort you give and on a pet’s predisposition (some develop plaque and tartar easily and require brushing more frequently than others).

GETTING STARTED

Equipment/materials needed:

Pet toothbrush or child’s/pediatric toothbrush
Pet tooth paste

It is important to use toothpaste formulated specifically for pets. There are many available in flavors pets like, such as poultry or seafood. Human toothpaste is to be avoided, as it can cause stomach upset if swallowed. Baking soda, with its very high sodium content, can have unintended adverse health effects in dogs and cats with certain illnesses. Hydrogen peroxide can be too harsh for the gums and can cause nausea if swallowed. Perhaps the most important point to consider is that this simple preventive can become part of a daily routine and, when followed by a treat, becomes something a dog or cat enjoys.

TROUBLESHOOTING BEFOREHAND

It is easy to train pets when they are young to enjoy having their teeth brushed. Older pets, on the other hand, tend to develop more periodontal disease, and their mouths and/or gums may be tender to the touch. A complete dental cleaning under general anesthesia performed by your veterinarian may be required prior to initiating toothbrushing. Once all of the plaque, tartar and, if necessary, diseased teeth have been removed, you will have greater success.

PROCEDURE

Try to brush the teeth at the same time each day so your pet gets into a routine. Late in the evening can work well if everyone involved is in a quieter mood. If your pet is highly motivated by food, try just before dinner, with the meal acting as a reward for cooperating.
The first step is to work with your pet’s mouth. With a little patience, your pet will soon accept your attention. Make it fun for both of you. Use a lot of love and praise to gain a pet’s confidence.
Start by handling the muzzle and lips. Soon you should be able to rub the teeth and gums with your finger. Place a little bit of soft cheese (for dogs) or tuna juice (for cats) on your finger when doing this. Many pets will then look forward to this treat.
Next, use a soft toothbrush to brush the teeth.
Several veterinary brushes are available, and many human(children’s) soft-bristle brushes are well suited to animal use.
Finger brushes are not appropriate as they are ineffective.
Place a small (pea-sized) amount of toothpaste on the bristles of the brush, lift the upper lip, place the brush on the outer surface of the teeth, and brush gently in small circles.
You need only brush the upper teeth, and only the outside surfaces (the side of the teeth facing out, not the side of the teeth facing the tongue). Making it a game that ends in a reward is the key to enjoying this and making it easy on you and your pet.• Brushing at least three times weekly is recommended, and once a day is ideal.

AFTERWARDS

By following a consistent program of home care, you will greatly improve your pet’s dental health. This will mean easier professional cleanings, less tooth loss, and a happier, healthier pet. However, there is no substitute for professional veterinary dental care. The biggest part of the tooth lies underneath the gums, and your pet must be anesthetized (asleep) to work with that “under the gum” area.

FREQUENTLY ASKED QUESTIONS

Can’t I just give my dog dental chew toys?
No, dental chews do not substitute for toothbrushing or for veterinary cleanings. These chews can help keep the teeth healthy, but don’t do the same thing as brushing. Avoid cow hooves, dried or cooked natural bones or hard nylon products that can actually break teeth, or become lodged in the gastrointestinal tract.

What is a complete dental?
Your veterinarian is the only professional allowed to perform a complete dental cleaning (“dental prophylaxis”) on your pet. Pets are placed under anesthesia that is continuously monitored. The teeth are cleaned, and the gumline is scaled and probed. Dental radiographs (x-rays) may be recommended, as it is difficult to determine the extent of dental disease without them. These thorough examinations can also detect oral cancer while it is still small and most treatable. Whether or not a complete dental cleaning is necessary can be determined during a routine checkup.

My local groomer performs dental work. Is this safe?
Your local groomer may brush your pet’s teeth, but groomers cannot legally or safely perform complete dental cleanings. Correct dental procedures require anesthesia, because much of the root of dental disease lies below the gumline; only veterinarians are allowed to administer anesthesia.

How long will it take for my pet to become used to having his or her teeth brushed?
It depends on the pet; however, it is advised to start with one or two teeth per day, slowly working your way around the mouth. Each day you can add one more tooth. Within several days, it is usually possible to brush the entire mouth in one sitting.
Why do small-breed dogs have more dental disease than large-breed dogs?
Small-breed dogs are more likely to have dental disease than large-breed dogs because they generally do not chew on toys as much as large-breed dogs. Occasionally, small-breed dogs are fed a softer diet than that of large-breed dogs, which decreases the “scraping mechanism” that dry dog food plays on the teeth. Finally, there is likely some genetic predisposition in certain breeds that makes them more susceptible to dental disease.

Should I wear gloves when brushing my pet’s teeth?
Ideally, yes; medical-grade exam gloves should be worn when working in any bacteria-prevalent area. Always wash your hands when you are finished.

BACKGROUND
When a dog or cat is dehydrated or at risk of dehydration, there are several ways to maintain or recover normal hydration. These methods include oral fluid administration (drinking or syringe-feeding), intravenous fluid administration (fluids that flow through an IV into the vein), or subcutaneous fluid administration. Subcutaneous fluids are given with a needle and deposited under the skin (the skin is the cutis, and subcutaneous means under the skin). When given in this way, fluids are absorbed slowly over several hours. This can be done in both cats and dogs and may be recommended by your veterinarian as a form of treatment to be done at home.

GETTING STARTED

In order to give subcutaneous fluids at home, you will need the following supplies provided to you by your veterinary hospital:

Sterile needles
A sterile fluid line
A sterile bag of fluids
A receptacle for used needles. You can dispose of used needles in a thick plastic container with a lid, such as an empty laundry detergent bottle, that can be taken to your veterinarian for disposal
A way to keep the fluid bag high, either by hanging or having an assistant hold the bag. The higher the bag of fluids compared to the pet, the faster the fluids will flow by gravity.
Something to distract your pet can be helpful. Canned cheese works well for many pets. Once the fluid is flowing, a peasized dab of cheese that the pet can lick off your finger every few minutes can make for a pleasant distraction.

Setting Up

Your pet need not be present for the setup. First, wash your hands before you assemble the fluid bag, fluid line, and needle. Fluid bags come in a wrapper, so at first use of a bag you will need to remove the wrapper. Next, identify the bottom of the bag, which usually has two ports (short tubes) protruding from the end. One of these has a removable cover, which is typically a plastic tab or sleeve that can be peeled back and off the bag. You should do this, revealing a tube that is the entry port for the fluid line connector. NOTE: the inside of this tube (the entry port) is sterile, so be sure you only touch the outside of it, and don’t reach inside it with anything.

Remove the fluid line from its wrapper. This is the coiled clear plastic tubing. One or more flat plastic tabs—often blue or green—will be entrapped in the tubing of the fluid line. These are sliding clamps, and they have keyhole-shaped slits that allow you to close off the flow in the tubing. You should slide one of these clamps (any one) into the closed position now: a firm slide such that the tubing moves from the wide to the narrow slot in the clamp’s keyhole, and the tubing is pinched shut. The whole line of tubing is likely coiled and secured by a paper tie that you can easily tear off. Both ends of the tubing are capped; the end you are interested in is the large end, with the clear plastic tubular chamber. Remove the cap from this end, revealing a plastic spike-shaped tip. Do not touch it, as it is sterile, and contact from your skin to the spike could allow bacteria from your fingers to wind up in your pet’s tissues. Insert this spiked end into the entry port of the fluid bag. Using a moderate amount of pressure and a twisting back-and-forth motion, advance the spike until it is fully seated into the port: for right-handed people, the transparent chamber of the spike end of the tubing is held in the right hand, and the port of the fluid bag is held in the left. The spike will puncture a membrane in the port; when the bag is held with the fluid line at the bottom, fluid will drip into the chamber. Now, hang the bag of fluids at a level higher than where your pet will be receiving them. For example, the bag can be hung by its loop (at the top of the bag) off the handle of a kitchen cabinet door. Or, you can slip the loop over a coat hanger that you then hang up on a coat rack (or anything else!). If you have a helper, the helper can even hold the bag up high when it is time to start rather than hanging the bag. You will know the top from the bottom of the fluid bag because the print on the bag should be upright when the bag is positioned properly. Remember that the higher the fluid bag compared to the pet, the faster the flow. With the open end of the tubing over a sink or bowl, remove the cap and set it aside. Be sure to avoid touching the open end of the tubing with your finger or anything else. Only the cap or a new needle should ever contact the tip; this preserves its sterility. Open all clamps on the fluid line, including a roller valve (small wheel in a rectangular plastic box) if one is present, and allow fluid to run out
the line. Be sure to allow the flow to continue for several seconds to remove the air, including large bubbles, throughout the length of the tubing, then close one clamp to stop flow. A few small (rice grain–size) bubbles are not a problem, but air that fills more than an inch or two (few centimeters) of the tubing should be purged by reopening the clamp and allowing more fluid to flow. Attach a covered needle to the fluid line on the opposite end from the chamber that is now stuck in the fluid bag. Examine the clear plastic cylinder again, near the fluid bag. It should be approximately half filled with fluid and half with air.

This way, you will be able to see dripping of fluid from the bag into the cylinder when the fluids are being administered. If this cylinder is completely filled with fluid, turn it and the bag upside down and squeeze the cylinder, forcing some fluid back into the bag and some air back into the cylinder. The system is now ready to deliver fluids. The process of assembling the setup that you just performed only has to be done once for each new bag of fluids, not with every treatment. Depending on the size of the bag and the dose of fluids you will give, one bag might last for several days.

The fluids (right) for subcutaneous administration come in a plastic wrapper, as does the fluid line (left) that will be connected to the bag. This same bag and line can be used multiple times, until empty, but the needle must be changed after every use.

The fluid line is inserted into the fluid bag through a port at the bottom of the bag. The port should be uncovered immediately before insertion of the fluid line. The spike end of the fluid line (opposite the end where the needle will be placed) is uncapped, and firmly inserted into the port until fully seated. At this point, fluid will be able to flow from the bag.

Once the fluid line is connected to the fluid bag, the roller clamp and any squeeze clamps are opened to allow flow of fluid to remove air bubbles. The clamps are then closed again while the bag is hung in place prior to fluid administration.

It is helpful to set up one area in your house for administering fluids. This way, the fluid bag can be hung up, and materials will be within easy reach, leaving both your hands free to handle the pet and the fluid line. An assistant is nice, but often unnecessary.

TROUBLESHOOTING BEFOREHAND

Remember that the fluids and the fluid line must remain absolutely sterile on their inside surfaces. This means not touching the end of the fluid line or leaving it uncapped. When not in use, the fluid line should be clamped and the end capped with a new needle.
Do not use fluids that are cloudy. This is most commonly a sign that the fluids have been contaminated; a new fluid bag is necessary.

The fluid bag should be held or hung above the pet so that gravity allows for fluid flow. A simple coat hanger can be used to hang the bag on any taller purchase, such as the cat climbing toy in this picture. The pet can rest on a lap or in another comfortable position during fluid administration. Most animals will require a hand to keep them from leaving, but some will simply lie still, as did this dog.

There are different sizes of needles. Most commonly, a 20- or22-gauge needle is provided. The 22-gauge needle has a smaller diameter than the 20-gauge. This means it isn’t felt as much by the pet when being pushed into the skin, but because it is smaller, the 22-gauge needle delivers fluids more slowly than a larger-diameter needle like the 20-gauge.
Expect to use the same bag of fluids over and over until it is empty, the same fluid line until the bag is empty, but a new needle every time you administer fluids. The needle must be both clean and sharp, so must be replaced each time.
Although fluids may be safely stored at room temperature, they may be too cold to be comfortable for a pet. Handle the bag, and place it against your bare arm. If the bag feels cool, consider warming it slightly before administration. Never microwave fluids that are meant to be injected. A good option is to hold the bag against your body for 20-30 minutes to bring the fluids up to your body temperature.

PROCEDURE FOR ADMINISTERING FLUIDS

Start by bringing the pet into the prepared area. Petting and/or treats are a good idea to help him or her relax. 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. Note the amount of fluid in the bag as the starting point, and note your veterinarian’s directions about how much to give. Bags will have a volume marker on the outside, but they are a rough guide. The fluid dose does not have to be exact.

Place yourself and your pet in a comfortable position near the fluid bag with the needle end of the fluid line in easy reach. Then, practice “tenting” the skin on the back of the neck between the shoulder blades. This means pulling up some skin between your thumb and index finger and creating a triangular tent shape in the skin that lies behind the neck at the topmost part of the shoulders (where the front legs are). The skin in this area is strong and insensitive, so it is the preferred location for administering the fluids. Practice handling the needle with your dominant hand (for example, your right hand if you are right-handed), and handle the pet with the other hand.

Now, to give the fluids, uncap the needle that is on the end of the fluid line, and hold the needle in your dominant (e.g., right) hand the same way you would hold a pen or pencil. The needle will be directed 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, or any of the pet’s underlying muscles or bones. Prepare the skin tent, elevating the skin between the shoulders using your left hand. Advance the needle through the skin, in a direction that is parallel to the pet’s spine or back. Insert quickly and smoothly but without jabbing. Normally you will likely feel a small amount of resistance at the skin surface and then a soft release as the needle passes through the skin. Be sure not to stick the needle all the way through and out the other side of the skin. Once the needle is placed, the skin tent can be released. Holding the needle in place may be necessary if the pet moves at all. At first this takes time, but with practice, the time from uncapping the needle to having it in place is typically less than 10 seconds.

Next, unclamp the fluid line, and allow the fluids to flow. You should be able to see the fluid dripping into the cylinder just below the bag hanging above you, but you won’t see the fluid move in the line. You should start to see the skin begin to bulge up as the fluid accumulates underneath. This is not painful for the pet, but petting and comforting them can help keep them still during the time necessary to deliver the amount of fluids recommended by your veterinarian. When the desired amount has been given (monitoring the level on the bag itself), reclamp the fluid line and remove the needle from the skin. Replace the needle cover, and immediately change to a new covered needle to protect the end of the fluid line until the next time fluids are delivered. Dispose of the old needle in a purpose-made sharps receptacle or another rigid container such as the laundry detergent bottle.

AFTERWARDS
For larger amounts of fluids or in smaller pets, it may be necessary to divide the total amount of fluid into two different areas. These areas can be side by side or one in front of the other, and your veterinarian will instruct you on this if it is necessary. Be sure to keep used needles in a safe place away from misuse or accidents and to dispose of them in accordance with local laws governing medical waste.

FREQUENTLY ASKED QUESTIONS

What if my pet runs off in the middle of the fluid administration?
If this happens, calmly clamp off the fluid line and change the needle to a new one. Simply stopping midway through the process is not harmful, but it means the full amount of fluid was not received. It may be helpful to have someone help you (especially by petting, talking to, or otherwise distracting the pet) when you administer the fluids again. If it is a recurrent problem, or if you are concerned that your pet is intolerant to the point of aggression (biting, scratching), contact your veterinarian to discuss alternatives.

Does it hurt?
No. The area of skin between the shoulder blades is very insensitive on a dog or cat’s body. With rare exceptions, such as when there is skin disease or another disorder of that area of the body, the vast majority of dogs and cats show no discomfort at all with this approach.

There is fluid leaking out of the hole in my pet’s skin where the needle just came out. Is this a problem?
A small amount of fluid leakage is common after withdrawing the needle. This can be prevented by gently rubbing the area where the needle was removed for a few seconds afterward. If leakage is occurring during the fluid administration, the needle is likely not far enough in (has slipped back out the skin) or is too far in (has emerged through the other side of the skin tent). In such cases, you should withdraw the needle and reinsert it in order to finish giving the right amount of fluids.

Fluid isn’t flowing. What is wrong?
If the bag is new, be sure the spike of the fluid line is completely inserted into the bag. Then check all the clamps. There may be several. Be sure all clamps of all types are in the open position. Examine the tubing of the fluid line. Sometimes the tube can be kinked or twisted. Pinching or untwisting a kinked section should restore the normal uniform shape of the tube. Examine the cylinder up near the end of the fluid line that is inserted into the bag. If fluid is dripping into this cylinder, then fluid is flowing. If fluid is still not flowing, you may adjust the needle position by withdrawing it half an inch (1 cm) in case the needle tip was abutting against something that was blocking it. Finally, you can raise the fluid bag higher compared to your pet’s position.

BACKGROUND
If your pet has sustained an eye injury, has an eye infection or an internal medical condition that is affecting the eyes, or is recovering from eye surgery, it may be necessary for you to give one or several medications into the eye(s) to help with healing. At first the idea of one person giving eye medications to a wiggly pet may seem like a daunting task, but it is possible. Practicing the following approach should help you safely deliver the recommended eye medications.

GETTING STARTED
Depending on the severity of the eye problem, one or more medications may have been prescribed for your pet. The first step in handling eye (“ophthalmic,” “ocular”) medications is understanding how much of each medication to give, when to give them, and which ones (if any) should be refrigerated. This information is on the label of most eye medications and can be explained to you by a veterinary technician if it is unclear. Eye medications may be prescribed to be used very frequently or much less so, ranging from 1 time daily to hourly, ideally equally spaced apart over time throughout the day. In some situations, continuing a schedule through the night may be important in the short term to prevent progression of an injury or infection and to potentially avoid eye surgery. In these situations, you should discuss with your veterinarian what the best schedule is before your pet leaves the hospital.

It is also common to need to place an Elizabethan collar (E-collar, “lampshade”) on your pet. This simple device can be tremendously helpful in protecting the eye from your pet’s desire to rub it, especially once it starts to heal and becomes itchy. These collars provide the best protection when they are worn 24 hours a day, since it only takes a few minutes to damage delicate tissue that has taken days to heal.

With medium- or long-nosed dogs, an E-collar can be kept on when administering eye medications, but with short-nosed dogs and many cats, it is easier to remove the E-collar and then replace it after giving the medication.

TROUBLESHOOTING BEFOREHAND

If your pet is extremely energetic or has a small face or short snout, it may be more difficult for you to get medications into the eyes. At first, it may be helpful for you to have a second person available to help hold the pet still. If you are applying more than one kind of drop, or both ointment and drops, then be aware of timing and order of administration. Drops are always first, and ointments are always last; otherwise the ointment can create a barrier that prevents the drops from working. To allow absorption of each medication, it is ideal to leave 5 minutes between giving each medication. Allowing for extra time in your daily routine to accomplish this type of schedule is almost always necessary. In some cases, this is temporary (if the injury or disease is cured), whereas in other cases this type of treatment continues long term or permanently. You can ask your veterinarian about what is expected in terms of having to continue to give ocular medications.

PROCEDURE FOR ADMINISTERING EYE MEDICATION
First, situate yourself so that you can hold your pet’s head. For cats and small dogs, this means putting them on your lap or placing them on a table. For medium and large dogs, this means kneeling down or arranging them so their hind end is between your knees or ankles while you are standing. This approach should also help keep them still.Second, lift your pet’s head so the eyes and nose are pointing as straight upward as possible, ideally toward the ceiling. For a right-handed person, this is done using the left hand.
Drops

Hold the bottle or dropper like a pencil in your right hand, and use the edge of your right palm to slide back the skin above the upper eyelid. This will lift the upper eyelid and expose the eye. Use the thumb or middle finger of your left hand, which is still elevating the chin to keep the head pointing toward the ceiling, to draw down the skin below the lower eyelid, further parting the eyelids and opening the eye. Without allowing the applicator tip to touch the surface of the eye, bring the bottle/dropper close to the eye, and squeeze the bottle such that a drop of the liquid medication falls onto the eye surface.

Ointment

Using the same approach described for drops, squeeze approximately a 1/4-inch strip of ointment from the tube, and drape this strip of ointment across the surface of the eye, again taking care not to touch the eye with the applicator tip. a When finished, close the eyelids, and gently massage the strip of ointment over the surface of the eye unless the eye is fragile or just had surgery.Some surgeries to the eye require that the lids are temporarily secured closed with sutures (stitches). Some infections or traumatic injuries cause massive swelling to the eyelids. In these cases, sometimes only a small portion of the eye can be seen. Often, the visible portion of the eye is the corner near the snout. In giving eye medications in these situations, the approach described above can still be used, but the drops or ointment are placed in the corner of the eye. Drops should run across the eye (under the eyelids) easily on their own. Normal movement of the eye will help distribute ointment.

AFTERWARDS
If you find that it is only possible to give eye medications by first removing your pet’s E-collar, be sure to protect the eyes from rubbing against the collar when you remove or replace it. For example, if you slip the collar over their head without taking the collar completely apart, you should hold your hand over your pet’s eyes as you slide the collar back into place. This will help prevent damage to the eye(s).

FREQUENTLY ASKED QUESTIONS

Each morning my pet’s eye has dried discharge on it. Is that a problem?
A small amount (dry rice grain size or less) of black or yellow material is normal. Larger amounts are common with recovery from infection, traumatic injury, or surgery. If it is dried and caked, it should be removed to prevent a deeper infection. Hold the corner of a clean washcloth soaked with lukewarm water on the dried material to help it soften. Then gently wipe it away.

My pet had an infection in one eye, but now the other eye looks red/itchy/has discharge. What do I do?
This could be evidence that the infection has spread to the other eye. However, there are other explanations (such as dry eye, allergy flare-ups, or intraocular disorders) that can masquerade as a spreading infection. You should call your veterinarian or schedule a recheck appointment to determine the appropriate treatment.

I simply cannot get the medication in the eye. My pet shakes away, and I am afraid I will cause more harm than good. What do I do?
There are some oral medication substitutes (syrups, tablets, etc.) and some injections that can help with certain eye problems. Above all, the first rule is to do no harm: if you are concerned you may hurt your pet—or may get hurt (e.g., bitten)—then do not administer the medication, but do call your veterinarian back the same day to make an appointment and review whether there is a different technique, or a different form of medication altogether, that is preferable.

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