Medical 101: How to save lives on a shoe-string

Medical 101: How to save lives on a shoe-stringEllen Jefferson, DVMAustin Pets Alive!www.austinpetsalive.org

Legal RequirementsCheck your state laws

We recommend you buy and read Shelter Medicine for Veterinarians and Staff by Miller and Zawistowski to learn more about the legal intricacies of running a shelter.

Rabies testing in all bite cases or death from neuro disease with course less than 10 days. Law and morally correct thing to do.

The Basics- IntakeCatsFvrcpFrontlineStrongidChipRabiesFelv/fiv test

DogsDHLPPBordetellaStrongidChipRabiesHw Test (6 months and older only)Ivermectin

The Basics - Spay/NeuterDrugsInduction- Dogs- Ketamine/Acepromazine IVCats- ketamine/Valium IVMaintenanceIsoflourane gasPain Control3 prong: morphine, metacam, lidocaine

Performance MeasureAnimals dont wait longer than 24 hours from adoption to home (best practice)Staffing1 doctor- 30-40 per day2-3 techsFollow high volume spay/neuter clinic structure

Wellness ScheduleVaccines every 2 weeks (between 4 weeks and 4 months)Adults: 2 vaccines Deworm every 14-30 daysFrontline every 30 daysIvomec- sarcoptes prevention

Traditional Thought Process at Shelters for incoming ill/injured animals

How is Medical Care Different in a No Kill City?The goal is to save all salvageable animals, no matter the problemTreat as if will live

Systemizing treatments makes it easier

Get them out!Saves space, money, time

Euthanasia is not an option

Euthanasia vs. Kill Definition of Euthanasia:The deliberate ending of a life suffering from an incurable, painful, deadly condition For reasons of mercy because without euthanasia, natural death would be preceded by extreme sufferingDefinition of KillThe deliberate ending of a life NOT suffering from an incurable, painful, deadly condition

Reasons animals are justifiably Euthanized at No Kill Shelters Ideally

Dying from Trauma upon arrival or after initial treatmentWhite gums, shocky, Body will not be functional again even with medical helpBroken spine, severely maimed

Dying from Illness upon arrival or after initial treatmentFlat out white gums, cold

Chronic condition that will result in pets death eventually, painfully even with helpBad arthritis, cachexia

Untreatable aggression as diagnosed by a behaviorist

2 options for herd health in a shelter that is trying to become No Kill1. Spread funds over all animals by incrementally giving the most basic care until all are savedAPAs choice2. Save some high dollar animals but not all who are salvageable due to limited fundsMost No Kill Shelters choice

TriageScarce Resource Management = Conservation of Life Saving ResourcesBeing flexible with drug choiceFollowing protocols for efficiencyElevating only the conditions that have the highest potential for life long problems to the most expensive resources

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Medical Reasons Animals are Killed in Traditional SheltersTraumaInjuriesHit By Car or other major traumaBroken bonesHead traumaWounds, burns, lacerationsToo young

DiseasesInfectionsChronic diseases that are difficult even for good owners to manageOld age diseasesDiseases caught at the shelter

How do we save money?Treat what we seeNo expensive tests unless really critical to treatmentWhat happens if the result is negative?

James Herriot MedicineNature is your biggest ally

Use what you have Dont order expensive drugs unless there is truly no alternativeThere almost always is

How do we save money?Ask for donations and helpTangible suppliesChip insFosters/adoptersAccept all donationsVolunteer helpBreak up tubes/bottles to share with out contaminationFrontlineEye medsFind alternatives to expensive medsEye meds, antibioticsFoster homes!

Dont skimp on:Pain medicineCleaning up wounds Proactive treatment on things that will probably get worseAnorexic catsEyesBaby illness

Raising Money for Cici

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Cicis foster helps raise funds

InjuriesHit By CarMost injuries that you see immediately after an accident, will improve with time Within 24-72 hoursPain managementHydration, treat the obviousRe-evaluateSomewhat unreliable Indicators of the future right after the accident:Head traumaSpinal reflexesBlindnessMobilityIncontinenceBiting due to pain

Must be willing to deal with it if worse than you thought

Supportive Care for TraumaWatch for 24 hoursComfy bed Pain meds

Support broken bonesSplint, slingPaddingBubble wrap

Common Pain KillersTramadol- not controlled

Common Anti-InflammatoriesNSAIDSAs long as well hydrated and eatingPrednisone dont use in shelter, most likely infectious

Case Study- CodaFound by a dumpsterSemicomatoseCouldnt stand or seeR/O for swollen head in a ChihuahuaHydrocephalus- poor pxHead trauma- good pxGave him 72 hoursantiinflammatoriesCost $15

Case Study-Rusty

Anti-inflammatoriesXraysCost= $100

Bone FracturesSurgery or no surgery?Decision making process at APASplint/sling- Immobilization TheoryTime

Amputation: Open wounds where bone has popped through Limb is not functioning AND it is mutilatedNot used instead of fixation for long bone fractures

Bone Surgery (pins or plates or FHO)Only if joint is effected and size mattersIf doesnt heal with splinting and/or timeIf more than one leg

Benefits and Risks of Bone Fracture PolicyBenefitsSaves more lives because more money can be spread amongst more animalsCosts lessDecreases transportation needs to and from vetRisksMay heal in weird way or incorrectlyLonger to healMay not heal at allRegular vets can get angry if not clearly explained why in notesAdopters can get angry if not educated

Case Study- LilyCouldnt put her feet down

Cost $200

Case Study- Honey Biscuit

Note from Honey Biscuit Foster to new foster for another hurt kitty

She was a total sweetheart and so easy to treat, also hit by a car, with a broken jaw and blind. As soon as her story was posted on the APA blog, she had enough donations to cover her surgery costs (within the first couple of hours!) and an amazing family to adopt her! I would take this little boy in a heartbeat, it was such a rewarding experience to seeBiscuitmend and find a great home, however I have a medical foster kitty already who needs to be syringe fed due to liver issues LOL

I am happy to help anyone who does take Lincoln with advice, supplies, etc, Hope you can give him a chance :)

Honey Biscuit in Her New HomeCost: $350

Case Study- Elsie EthringtonShelter vet said she must be euthanized immediately6 fractures in pelvis

8 weeks laterCost: $200

Case Study- Biggie

Bandaged for 2 monthsAmputationCost $400

Lesson learned and now part of protocol29

Case Study- Honey and Mr ZBurns all over bodyLeg contractedCosts: $300All four feet effectedBurns on back will healFeet will contract use wet bandages3 months of bandages

Case Study- ChicoBitten by bigger dog

Will heal but surgery is best

Should not be euthed for thisCost $170

Chico in foster home recovering

Case Study- Snake Bite DogBig open woundDog is stable otherwise

Long term antibiotics, salve, bandages if possibleSurgery to close edges preferred but not essentialCost $50

Case Study- Eye popped out

Nonpainful because damage was done long before she came to the shelterNeeded to be removedPeople will contribute to this$150-300

If the pet is still fighting.Eating = will to liveEven if something looks horrific, if pet is eating, that is a good prognostic signMay not eat immediately with trauma

Infections

Skin InfectionsMangeRingwormViral InfectionsParvoParasite InfectionsHeartwormsGI WormsFleas/ticks

Next section we will cover36

Sarcoptic Mange TreatmentSarcopticHard to find foster

Control sarcoptes in shelter populationTreat all dogs weekly0.15/ 10lbs orally IvomecPrevention

Not contagious as soon as not itchy anymore (2 weeks)

6 weeks treatment with ivermectin OR revolution every 2-3 weeks x 3 treatmentsPinna testCost