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Medical 101: How to save lives on a shoe-string budget
This document provides guidance on how to provide medical care to animals in a shelter or rescue on a limited budget. It discusses legal requirements, intake procedures, spay/neuter protocols, vaccination schedules, common injuries and illnesses seen, and approaches to treatment. For injuries and illnesses, it outlines treatment plans and estimated costs for various case studies. It emphasizes treating all salvageable animals regardless of condition and focusing on quality of life rather than euthanasia. Hospice and palliative care are discussed as options for aging or critically ill pets.
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Medical 101: How to save lives on a shoe-string budget
- 1. Medical 101: Howto save lives on a shoe-string Ellen Jefferson, DVM Austin Pets Alive! www.austinpetsalive.org
- 2. Legal Requirements Checkyour 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. 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. 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. Wellness Schedule Vaccinesevery 2 weeks (between 4 weeks and 4 months) Adults: 2 vaccines Deworm every 14- 30 days Frontline every 30 days Ivomec- sarcoptes prevention
- 6. Traditional Thought Processat Shelters for incoming ill/injured animals Treat just enough to stay alive for stray hold Euthanize immediately due to “suffering”
- 7. How is MedicalCare 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. 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. Reasons animals arejustifiably 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. 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. 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. Medical Reasons Animalsare 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. How do wesave 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. How do wesave 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. Don’t skimp on: Pain medicine Cleaning up wounds Proactive treatment on things that will probably get worse ◦ Anorexic cats ◦ Eyes ◦ Baby illness
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- 17. Cici’s foster helpsraise funds
- 18. Injuries Hit ByCar ◦ 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. Supportive Care forTrauma 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. 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. Case Study-Rusty Anti-inflammatories Xrays Cost= $100
- 22. Bone Fractures Surgeryor 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. Benefits and Risksof 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. Case Study- Lily Couldn’t put her feet down Cost $200
- 25. Case Study- HoneyBiscuit
- 26. Note from HoneyBiscuit 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. Honey Biscuit inHer New Home Cost: $350
- 28. Case Study- ElsieEthrington Shelter vet said she must be euthanized immediately 6 fractures in pelvis 8 weeks later Cost: $200
- 29. Case Study- Biggie Bandaged for 2 months Amputation Cost $400
- 30. Case Study- Honeyand 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. Case Study- Chico Bitten by bigger dog Will heal but surgery is best Should not be euthed for this Cost $170
- 32. Chico in fosterhome recovering
- 33. Case Study- SnakeBite 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. Case Study- Eyepopped 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. If the petis 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. Infections Skin Infections ◦Mange ◦ Ringworm Viral Infections ◦ Parvo Parasite Infections ◦ Heartworms ◦ GI Worms ◦ Fleas/ticks
- 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. Mild to ModerateGeneralized Demodex Promeris x 2-3 doses ◦ Recommend use for life Cephalexin x 2 weeks Deworm Adopt as is
- 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
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- 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. die in ahome 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. 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. 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. HEARTWORMS 179 cases seenin 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. Heartworm Treatment Pretreat- 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. GI Parasites Whyare 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. Chronic diseases thatrequire lifelong management Feline Leukemia FIV IBD/Allergies Arthritis Kidney failure/Diabetes Hypo/hyper thyroid
- 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. Contagious diseases caughtat the shelter Distemper ◦ Kennel Cough URI in cats Stress ◦ Hepatic Lipidosis Ringworm GI Parasites
- 51. Cat URI Vaccinesprevent severe cases ◦ Nebulizing ◦ Force feeding ◦ Amoxi if mild ◦ zithro or baytril if severe ◦ Eye meds Idoxuridine Gentamicin Make your own! ◦ Foster
- 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. Ringworm caught atshelter Can take days to weeks to show up Always look for it on intake and before adoption and exposing other cats Lyme Dip?
- 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. How do youset 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
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