Medical 101: How to save
lives on a shoe-string
Ellen Jefferson, DVM
Austin Pets Alive!
www.austinpetsalive.org
Legal Requirements
 Check your state laws
 We recommend you buy and read “Shelter
Medicine for Veterinarians and Staff” ...
The Basics- Intake
 Cats
◦ Fvrcp
◦ Frontline
◦ Strongid
◦ Chip
◦ Rabies
◦ Felv/fiv test
 Dogs
◦ DHLPP
◦ Bordetella
◦ Str...
The Basics - Spay/Neuter
 Drugs
◦ Induction-
 Dogs-
Ketamine/Acepromazine
IV
 Cats- ketamine/Valium
IV
◦ Maintenance
 ...
Wellness Schedule
 Vaccines every 2
weeks (between 4
weeks and 4
months)
 Adults: 2 vaccines
 Deworm every 14-
30 days
...
Traditional Thought Process at
Shelters for incoming ill/injured
animals
Treat just enough to
stay alive for stray
hold
Eu...
How is Medical Care Different in
a No Kill City?
 The goal is to save all
salvageable animals, no
matter the problem
◦ Tr...
Euthanasia vs. Kill
 Definition of Euthanasia:
◦ The deliberate ending of a life suffering
from an incurable, painful, de...
Reasons animals are justifiably
Euthanized at No Kill Shelters
Ideally
 Dying from Trauma upon arrival or after initial t...
2 options for “herd health” in a
shelter that is trying to become No
Kill
1. Spread funds over all
animals by
incrementall...
Triage
 Scarce Resource
Management =
Conservation of Life
Saving Resources
◦ Being flexible with
drug choice
◦ Following ...
Medical Reasons Animals are
Killed in Traditional Shelters
 Trauma
◦ Injuries
◦ Hit By Car or other
major trauma
◦ Broken...
How do we save money?
 Treat what we see
 No expensive tests unless
really critical to treatment
 What happens if the r...
How do we save money?
 Ask for donations and help
◦ Tangible supplies
◦ Chip ins
◦ Fosters/adopters
 Accept all donation...
Don’t skimp on:
 Pain medicine
 Cleaning up wounds
 Proactive treatment on things that will
probably get worse
◦ Anorex...
Raising Money for Cici
Cici’s foster helps raise funds
Injuries
 Hit By Car
◦ Most injuries that
you see immediately
after an
accident, will
improve with time
 Within 24-72 ho...
Supportive Care for Trauma
 Watch for 24 hours
◦ Comfy bed
◦ Pain meds
 Support broken
bones
◦ Splint, sling
◦ Padding
◦...
Case Study- Coda
 Found by a dumpster
 Semicomatose
 Couldn’t stand or see
 R/O for swollen head
in a Chihuahua
◦ Hydr...
Case Study-Rusty
 Anti-inflammatories
 Xrays
 Cost= $100
Bone Fractures
 Surgery or no surgery?
◦ Decision making process at
APA
 Splint/sling- Immobilization
Theory
 Time
 Am...
Benefits and Risks of Bone
Fracture Policy
 Benefits
◦ Saves more lives
because more
money can be
spread amongst
more ani...
Case Study- Lily
 Couldn’t 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, als...
Honey Biscuit in Her New Home
Cost: $350
Case Study- Elsie Ethrington
 Shelter vet said she
must be euthanized
immediately
 6 fractures in pelvis
 8 weeks later...
Case Study- Biggie
 Bandaged for 2
months
 Amputation
 Cost $400
Case Study- Honey and Mr Z
Burns all over body
Leg contracted
Costs: $300
 All four feet effected
 Burns on back will he...
Case Study- Chico
 Bitten by bigger
dog
 Will heal but
surgery is best
 Should not be
euthed for this
 Cost $170
Chico in foster home
recovering
Case Study- Snake Bite Dog
 Big open wound
 Dog is stable
otherwise
 Long term
antibiotics, salve, b
andages if possibl...
Case Study- Eye popped out
 Nonpainful
because damage
was done long
before she came to
the shelter
 Needed to be
removed...
If the pet is still fighting….
 Eating = will to live
 Even if something
looks horrific, if pet
is eating, that is a
goo...
Infections
 Skin Infections
◦ Mange
◦ Ringworm
 Viral Infections
◦ Parvo
 Parasite Infections
◦ Heartworms
◦ GI Worms
◦...
Sarcoptic Mange Treatment
 Sarcoptic
◦ Hard to find foster
◦ Control sarcoptes in shelter
population
 Treat all dogs wee...
Mild to Moderate Generalized
Demodex
 Promeris x 2-3
doses
◦ Recommend
use for life
 Cephalexin x 2
weeks
 Deworm
 Ado...
Severe Demodex – life
threatening
 Check for swelling in feet, will loose
protein
◦ Check PCV/TP
◦ Need refractometer and...
Case Study- Trudy
HOSPICE AND PALLIATIVE
CARE
 Austin Pets Alive! defines palliative care as the care of patients with a life-limiting illn...
die in a home and
with love
Goal – to save
animals from dying
in a shelter with no
care or
compassion. Part of
the last 15...
Viral Infection: Parvovirus
 Major problem
◦ ~400 per year at AAC
◦ Killed instantly along with littermates
 Contagious
...
Parvo Treatment Ward
 Why Treat?
◦ People want
puppies
◦ Better in about 7
days
◦ No lasting effects
 Ward is covered in...
HEARTWORMS
179 cases seen in 2013
◦ Very prevalent in Austin
 5.8% of intake
◦ 99% success rate with treatment
◦ ~$50-250...
Heartworm Treatment
 Pre treat-
 Doxycycline x 3 weeks
 Ensure over URI (don’t treat too
quickly)
 Prednisone – start ...
GI Parasites
 Why are these puppies and kittens with diarrhea
put down at shelters if not parvo?
◦ Still could be parvo, ...
Chronic diseases that require
lifelong management
 Feline Leukemia
 FIV
 IBD/Allergies
 Arthritis
 Kidney
failure/Dia...
Felv + Cats
 Serum testing!
 Kittens often
seroconvert
 Live 6 months-2
years
 Ward/Sanctuary
 Retest --Referring
she...
Contagious diseases caught at
the shelter
 Distemper
◦ Kennel Cough
 URI in cats
 Stress
◦ Hepatic Lipidosis
 Ringworm...
Cat URI
 Vaccines prevent
severe cases
◦ Nebulizing
◦ Force feeding
◦ Amoxi if mild
◦ zithro or baytril if
severe
◦ Eye m...
Ringworm Cats
The problem:
◦ Zoonotic
◦ Stigma
◦ Very contagious to other
cats in the shelter
Treatment:
◦ Terbinafine or ...
Ringworm caught at shelter
 Can take days
to weeks to
show up
 Always look for
it on intake and
before adoption
and expo...
Fat Cat Anorexia
 Force feed in
medical foster
ASAP
 Weigh daily
 Observe in
individual cage as
opposed to habitat
 Ap...
How do you set priorities when
you are trying to save all?
 Pull
◦ Acute problems
 Trauma, fractures, lacer
ations
 Sho...
Athena!
Medical 101: How to save lives on a shoe-string budget
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Medical 101: How to save lives on a shoe-string budget

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Presented at the American Pets Alive No-Kill Conference 2014.

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  • Lesson learned and now part of protocol
  • Next section we will cover
  • Last group to save
  • Medical 101: How to save lives on a shoe-string budget

    1. 1. Medical 101: How to save lives on a shoe-string Ellen Jefferson, DVM Austin Pets Alive! www.austinpetsalive.org
    2. 2. Legal Requirements  Check 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.
    3. 3. The Basics- Intake  Cats ◦ Fvrcp ◦ Frontline ◦ Strongid ◦ Chip ◦ Rabies ◦ Felv/fiv test  Dogs ◦ DHLPP ◦ Bordetella ◦ Strongid ◦ Chip ◦ Rabies ◦ Hw Test (6 months and older only) ◦ Ivermectin
    4. 4. The Basics - Spay/Neuter  Drugs ◦ Induction-  Dogs- Ketamine/Acepromazine IV  Cats- ketamine/Valium IV ◦ Maintenance  Isoflourane gas ◦ Pain Control  3 prong: morphine, metacam, lidocaine  Performance Measure ◦ Animals don’t wait longer than 24 hours from adoption to home (best practice)  Staffing ◦ 1 doctor- 30-40 per day ◦ 2-3 techs ◦ Follow high volume spay/neuter clinic structure
    5. 5. Wellness Schedule  Vaccines every 2 weeks (between 4 weeks and 4 months)  Adults: 2 vaccines  Deworm every 14- 30 days  Frontline every 30 days  Ivomec- sarcoptes prevention
    6. 6. Traditional Thought Process at Shelters for incoming ill/injured animals Treat just enough to stay alive for stray hold Euthanize immediately due to “suffering”
    7. 7. How is Medical Care Different in a No Kill City?  The goal is to save all salvageable animals, no matter the problem ◦ Treat as if will live ◦ Systemizing treatments makes it easier ◦ Get them out!  Saves space, money, time Treat to live Euthanasia is not an option
    8. 8. 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 suffering  Definition of Kill ◦ The deliberate ending of a life NOT suffering from an incurable, painful, deadly condition
    9. 9. Reasons animals are justifiably Euthanized at No Kill Shelters Ideally  Dying from Trauma upon arrival or after initial treatment ◦ White gums, shocky, ◦ Body will not be functional again even with medical help ◦ Broken spine, severely maimed  Dying from Illness upon arrival or after initial treatment ◦ Flat out –white gums, cold  Chronic condition that will result in pet’s death eventually, painfully even with help ◦ Bad arthritis, cachexia  Untreatable aggression as diagnosed by a behaviorist
    10. 10. 2 options for “herd health” in a shelter that is trying to become No Kill 1. Spread funds over all animals by incrementally giving the most basic care until all are saved ◦ APA’s choice 2. Save some high dollar animals but not all who are salvageable due to limited funds ◦ Most No Kill Shelter’s choice
    11. 11. Triage  Scarce Resource Management = Conservation of Life Saving Resources ◦ Being flexible with drug choice ◦ Following protocols for efficiency ◦ Elevating only the conditions that have the highest potential for life long problems to the most expensive resources
    12. 12. Medical Reasons Animals are Killed in Traditional Shelters  Trauma ◦ Injuries ◦ Hit By Car or other major trauma ◦ Broken bones ◦ Head trauma ◦ Wounds, burns, lace rations  Too young  Diseases ◦ Infections ◦ Chronic diseases that are difficult even for good owners to manage ◦ Old age diseases ◦ Diseases caught at the shelter
    13. 13. How do we save money?  Treat what we see  No expensive tests unless really critical to treatment  What happens if the result is negative?  James Herriot Medicine ◦ Nature is your biggest ally  Use what you have ◦ Don’t order expensive drugs unless there is truly no alternative  There almost always is
    14. 14. How do we save money?  Ask for donations and help ◦ Tangible supplies ◦ Chip ins ◦ Fosters/adopters  Accept all donations  Volunteer help  Break up tubes/bottles to share with out contamination ◦ Frontline ◦ Eye meds  Find alternatives to expensive meds ◦ Eye meds, antibiotics  Foster homes!
    15. 15. Don’t skimp on:  Pain medicine  Cleaning up wounds  Proactive treatment on things that will probably get worse ◦ Anorexic cats ◦ Eyes ◦ Baby illness
    16. 16. Raising Money for Cici
    17. 17. Cici’s foster helps raise funds
    18. 18. Injuries  Hit By Car ◦ Most injuries that you see immediately after an accident, will improve with time  Within 24-72 hours  Pain management  Hydration, treat the obvious  Re-evaluate  Somewhat unreliable Indicators of the future right after the accident: ◦ Head trauma ◦ Spinal reflexes ◦ Blindness ◦ Mobility ◦ Incontinence ◦ Biting due to pain Must be willing to deal with it if worse than you thought
    19. 19. Supportive Care for Trauma  Watch for 24 hours ◦ Comfy bed ◦ Pain meds  Support broken bones ◦ Splint, sling ◦ Padding ◦ Bubble wrap  Common Pain Killers ◦ Tramadol- not controlled  Common Anti- Inflammatories ◦ NSAIDS  As long as well hydrated and eating ◦ Prednisone – don’t use in shelter, most likely infectious
    20. 20. Case Study- Coda  Found by a dumpster  Semicomatose  Couldn’t stand or see  R/O for swollen head in a Chihuahua ◦ Hydrocephalus- poor px ◦ Head trauma- good px  Gave him 72 hours ◦ antiinflammatories  Cost $15
    21. 21. Case Study-Rusty  Anti-inflammatories  Xrays  Cost= $100
    22. 22. Bone Fractures  Surgery or no surgery? ◦ Decision making process at APA  Splint/sling- Immobilization Theory  Time  Amputation:  Open wounds where bone has popped through  Limb is not functioning AND it is mutilated  Not used instead of fixation for long bone fractures  Bone Surgery (pins or plates or FHO)  Only if joint is effected and size matters
    23. 23. Benefits and Risks of Bone Fracture Policy  Benefits ◦ Saves more lives because more money can be spread amongst more animals ◦ Costs less ◦ Decreases transportation needs to and from vet  Risks ◦ May heal in weird way or incorrectly ◦ Longer to heal ◦ May not heal at all ◦ Regular vets can get angry if not clearly explained why in notes ◦ Adopters can get angry if not educated
    24. 24. Case Study- Lily  Couldn’t put her feet down  Cost $200
    25. 25. Case Study- Honey Biscuit
    26. 26. 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 see Biscuit mend 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 :)
    27. 27. Honey Biscuit in Her New Home Cost: $350
    28. 28. Case Study- Elsie Ethrington  Shelter vet said she must be euthanized immediately  6 fractures in pelvis  8 weeks later  Cost: $200
    29. 29. Case Study- Biggie  Bandaged for 2 months  Amputation  Cost $400
    30. 30. Case Study- Honey and Mr Z Burns all over body Leg contracted Costs: $300  All four feet effected  Burns on back will heal  Feet will contract –use wet bandages  3 months of bandages
    31. 31. Case Study- Chico  Bitten by bigger dog  Will heal but surgery is best  Should not be euthed for this  Cost $170
    32. 32. Chico in foster home recovering
    33. 33. Case Study- Snake Bite Dog  Big open wound  Dog is stable otherwise  Long term antibiotics, salve, b andages if possible  Surgery to close edges preferred but not essential  Cost $50
    34. 34. Case Study- Eye popped out  Nonpainful because damage was done long before she came to the shelter  Needed to be removed  People will contribute to this  $150-300
    35. 35. If the pet is still fighting….  Eating = will to live  Even if something looks horrific, if pet is eating, that is a good prognostic sign  May not eat immediately with trauma
    36. 36. Infections  Skin Infections ◦ Mange ◦ Ringworm  Viral Infections ◦ Parvo  Parasite Infections ◦ Heartworms ◦ GI Worms ◦ Fleas/ticks
    37. 37. Sarcoptic Mange Treatment  Sarcoptic ◦ Hard to find foster ◦ Control sarcoptes in shelter population  Treat all dogs weekly  0.15/ 10lbs orally Ivomec  Prevention ◦ Not contagious as soon as not itchy anymore (2 weeks) ◦ 6 weeks treatment with ivermectin  OR revolution every 2-3 weeks x 3 treatments ◦ Pinna test ◦ Cost <$50  Demodex ◦ Easy to find foster ◦ Have to be careful about how long they are in foster if large breed puppies ◦ Will relapse when stressed ◦ 6 weeks+ ivermectin treatment depending on severity ◦ Can buy Promeris at Maak4pets.com ◦ Usually not itchy, don’t have to keep retesting as long as treatment is long enough ◦ $60
    38. 38. Mild to Moderate Generalized Demodex  Promeris x 2-3 doses ◦ Recommend use for life  Cephalexin x 2 weeks  Deworm  Adopt as is
    39. 39. Severe Demodex – life threatening  Check for swelling in feet, will loose protein ◦ Check PCV/TP ◦ Need refractometer and centrifuge only ◦ No lab work needed  Continue to treat mange ◦ Ivomec or Promeris, ◦ Painmeds? Crusty, bleeding skin? ◦ antibiotics
    40. 40. Case Study- Trudy
    41. 41. HOSPICE AND PALLIATIVE CARE  Austin Pets Alive! defines palliative care as the care of patients with a life-limiting illness that is not responsive to curative treatment or where curative treatment is not available or not applicable due to concurrent medical conditions, age, and other risk factors. Control of pain, and other symptoms, and frequent measuring of quality of life (appetite, activity, interaction with family members, pain assessment, hygiene) is paramount to optimal care. The goal of palliative care is achievement of the best quality of life for individual patients. Palliative treatment can be long term, for months or years and is also utilized for hospice patients.  Austin Pets Alive! supports hospice care as a means to provide support and care for patients in the last phases of incurable disease, or at the end of life. Hospice incorporates all of palliative care. A hospice case is expected to have a shortened lifespan and may only have a few weeks or months to live.  In both of these categories, heroic measures such as extensive hospitalization, advanced imaging, specialist referrals, and invasive surgery would not be pursued. Minimal laboratory or other diagnostic tests may be warranted. Pain medication and other available supplements, prescription diets, or other medications to treat chronic conditions would be utilized. These pets can be adopted as hospice or palliative patients with full disclosure of the medical condition and expected prognosis. The focus for these patients is on quality of life. One of the last groups we saved
    42. 42. die in a home and with love Goal – to save animals from dying in a shelter with no care or compassion. Part of the last 15% How – educate your fosters, no heroics, focus on QOL Who – felv, old, thin, possi ble cancer, congestive heart failure Joe - foot injuries, chronic diarrhea, geriatric
    43. 43. Viral Infection: Parvovirus  Major problem ◦ ~400 per year at AAC ◦ Killed instantly along with littermates  Contagious  High fear  Arguments against treating: ◦ Disease Control ◦ Cost
    44. 44. Parvo Treatment Ward  Why Treat? ◦ People want puppies ◦ Better in about 7 days ◦ No lasting effects  Ward is covered in other presentation ◦ Disease control is essential  Breaking ground in shelter treatment of Parvo
    45. 45. HEARTWORMS 179 cases seen in 2013 ◦ Very prevalent in Austin  5.8% of intake ◦ 99% success rate with treatment ◦ ~$50-250 to treat ◦ Post Adoption treatment  $0 adoption fee  $150 treatment fee  Reserve for most adoptable dogs
    46. 46. Heartworm Treatment  Pre treat-  Doxycycline x 3 weeks  Ensure over URI (don’t treat too quickly)  Prednisone – start 24 hours before injections  No x-rays/bloodwork  Waiver  Foster for at least 30 days  Back to back injections - 2  Ok to be adopted (or fostered by new owner until treatment) and then treated  Fundraising Campaigns help!
    47. 47. GI Parasites  Why are these puppies and kittens with diarrhea put down at shelters if not parvo? ◦ Still could be parvo, distemper, parasites are contagious too  Treatment Plan ◦ Control diarrhea  Panacur  Marquis (weekly)  Kaolin  Yogurt/bland diet ◦ Ensure hydration  Vomiting? Eating?  Sq fluids, anti vomiting meds, injectable meds  Parvo test ◦ Needs to be better in 24 hours or more action taken ◦ Faster, more aggressive treatment for little babies  Sq treatment
    48. 48. Chronic diseases that require lifelong management  Feline Leukemia  FIV  IBD/Allergies  Arthritis  Kidney failure/Diabetes  Hypo/hyper thyroid
    49. 49. Felv + Cats  Serum testing!  Kittens often seroconvert  Live 6 months-2 years  Ward/Sanctuary  Retest --Referring shelter often shows a different result  Specialized foster or adopter ◦ No cats  Lifelong care  Sell as “short term commitment”
    50. 50. Contagious diseases caught at the shelter  Distemper ◦ Kennel Cough  URI in cats  Stress ◦ Hepatic Lipidosis  Ringworm  GI Parasites
    51. 51. Cat URI  Vaccines prevent severe cases ◦ Nebulizing ◦ Force feeding ◦ Amoxi if mild ◦ zithro or baytril if severe ◦ Eye meds  Idoxuridine  Gentamicin  Make your own! ◦ Foster
    52. 52. Ringworm Cats The problem: ◦ Zoonotic ◦ Stigma ◦ Very contagious to other cats in the shelter Treatment: ◦ Terbinafine or Itraconazole  Check ALT if refill after 3 weeks or if showing signs of illness – not eating?! ◦ Lyme Sulfur Dips ◦ Black light to affirm diagnosis  Ringworm unless proven otherwise Strategies: ◦ Cattery entrance check list ◦ Adoption Events:  Adopt a Fun Guy!  Fun in Fungus!  Free Fun (gus) ◦ Display them  Winter months ◦ Ward  Volunteers
    53. 53. Ringworm caught at shelter  Can take days to weeks to show up  Always look for it on intake and before adoption and exposing other cats  Lyme Dip?
    54. 54. Fat Cat Anorexia  Force feed in medical foster ASAP  Weigh daily  Observe in individual cage as opposed to habitat  Appetite stimulants  SQ fluids
    55. 55. How do you set priorities when you are trying to save all?  Pull ◦ Acute problems  Trauma, fractures, lacer ations  Short term diseases that are treatable  Give body time to heal ◦ Chronic problems  That are not associated with incontinence ◦ Chip Ins  Think before pulling ◦ 2 or more legs unusable  Reason to pull: if acute injury ◦ Excessive drinking ◦ Chronic weight loss ◦ Incontinence- more than just from acute trauma (acute:<48hours) ◦ Chronic diarrhea in an adult ◦ Severe Arthritis  Maybe 1-2 cases at a time
    56. 56. Athena!

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