General Introduction and Comments
Wounds and Abscesses
Bite wounds and other punctures that then become abscesses are one of the most common problems we see in veterinary medicine.
We treat several a day at our clinic.
They are especially common and potentially deadly in cats.
Many people don't know their pet has an abscess; it's not always obvious, but what they do notice is that the pet has no energy, not much appetite, and is sore and often lame. Often tender too.
Open wounds are much more obvious, of course, but are listed along with abscesses since they are often related and the treatment is similar.
At Our Hospital: What to expect if an abscess is suspected:
(Of course, other vets may do things differently)
A good Examination: In addition to our normal overall exam, once we know we have or suspect an abscess, we pay special attention to fever (often very high), enlarged lymph nodes, pupil clarity, foreign bodies left in the wound, fistulation, and the extent of tissue damage or necrosis.
We also check for crepitus and gangrene.
Vocabulary Help: Fistulation refers to fibrous, reactive, spongy tissue under the skin. It greatly hinders wound healing. Crepitus refers to gas or bubble sounds under the skin...not a good sign.
Based on what we find on exam, we decide whether the wound or abscess is minor and likely to heal with just cleaning and antibiotics or is major and would be better treated with surgical draining, flushing, debridement, and repair in addition to antibiotics.
Here's What We're Likely to Do:
For minor wounds unlikely to need surgery but bad enough that they probably won't heal on their own:
After inspecting and cleaning the wound out, if minor and likely to heal without surgery, we will send your pet home with some type of topical would wash and/or antibiotic ointment. But first, we will usually give an
injection of antibiotics (usually I use gentocin mixed with high dose, long acting Penicillin ) combined with short acting steroid for inflammation and to reduce fever.
We may also elect to dispense oral antibiotics as well...all depending on how severe the wound. Every vet seems to have his or her favorite antibiotic for routine minor wounds. Others go to the expense of basing their choice on a culture and sensitivity test. I generally use once a day doxycyline in cats and cephalexin in dogs.
Be prepared to return for more aggressive treatment and/or more potent antibiotics if not improving quickly.
For Wounds and Abscess' bad enough that we should clean out the infected tissue under anesthesia:
Cats and dogs have very elastic skin with a fair amount of fatty tissue between the skin and the underlying muscle. This tissue is known as the subcutaneous tissue (SubQ). This important tissue, unfortunately, is fairly reactive (easily inflammed) and a warm, nutrient rich place for bacteria to thrive.
In cats, the problem of bacterial growth is especially bad because cat skin heals too quickly over a puncture...trapping the bacteria under the skin so that instead of draining out of the body...it reeks local destruction, tissue tunneling (fistulous tracts), endotoxin formation which is absorbed into the blood stream, and impressive abscessation.
Once this occurs, it's unlikely that antibiotics alone will cure the problem...you first have to open the area to drainage and clean out all the necrotic (damaged and rotten) tissue. Except in very tiny wounds, this needs to be done using either local or general anesthesia.
So, Here's the Protocol:
Presurgical Injection of Antibiotics to minimize the bacterial count.
PreAnesthetic blood work if deemed needed.
Anesthesia to allow painless wound prep and surgery.
Surgical cleaning, removal of damaged, necrotic, or fistulated tissue, and wound flushing.
This type of surgery can be quite easy and quick...or complicated by lots of bleeding, critical nearby tissues (for example; eyes or sphincter nerves), and time consuming extensive detail work.
Penrose or other types of drains may be needed
IV Fluids greatly minimize the death of tissue near the wound and maximize healing...so consider, especially for larger wounds.
For extremely large or destructive wounds, many vets like to recommend the newly availble Oxyhemaglobin and other similar products to minimize the chance of wound sloughing from tissue death. Oxyhemaglobin is a new type of non-reactive transfusion. Very expensive.
Depending on the type of wound and how old the wound, your vet will elect to suture or glue or staple the wound closed...or leave it totally or partially open for drainage. Open wounds will need daily cleaning and care.
Bandages and support wraps may be recommended for some wounds. If so, they will need to be managed, protected, and changed.
In addition to all of the above:
Antibiotics for at least a week.
Consider medications for itching and pain.
Medications for swelling and the control of inflammation
Consider post op injection of vitamin C to stimulate interstitial and integument healing.
Consider with your vet some of the "alternative" or controversial wound treatments such as topical colostrum, silver solutions, dmso applications etc. CoEnzymeQ10 to increase Oxygen perfusion of tissues.
Consider restraints such as elizabethan collars or chemical restraints (tranquillizers) to prevent self multilation if needed.
Hospitalization may be needed for a few days: usually not needed unless the wound is large or has a penrose drain in it that needs twice daily flushing. Depends on the case and whether or not the owner is willing or able to take care of the post op wound very well.
Patient and Wound monitoring. Be watchful for no appetite, poor energy level, and obvious poor wound healing. Be prepared to return to the clinic. Sometimes it takes several tries to get successful wound healing. There are lots of reasons why a wound might be difficult to cure. Don't be too quick to blame the vet.
Return for suture or staple removal if needed in 10-14 days.
Note: It's not likely that the bacteria in most dog and cat wounds/abscesses will be a danger to you, but do wash well after cleaning out and treating healing infections. And note that the bacteria in some other species...rabbits and reptiles...can be dangerous.
c Roger Ross DVM
Coming soon...information about...
Bite Wound Abscess' in Cats
Articles, Comments, and Information about wound care, treatment, and potential problems.
coming soon...
A little bit about the importance and history of antibiotics
Version One:
Back in 1929, penicillin was re-discovered by a Scottish researcher named Alexander Fleming (penicillin was originally discovered by a French medical student by the name of Duchesne).
It wasn't until 1941 in England, that an Australian (Howard Florey) and an Englishman (Ernst Chain) developed commercial methods to produce penicillin for human use. The TOTAL amount of penicillin available for use in the clinical trial on humans at that time, was LESS THAN the amount one would receive in a single shot, today!
At that time, of course, World-War II was in progress, and there was a major effort to try to make penicillin available to all of the British, U.S., and other allies involved with fighting Germany, Japan, and Italy. Because England did not have the industrial capacity necessary for large-scale production, nor protection from bombing raids, the entire process was moved to the United States. It is for this reason primarily, that the pharmaceutical industry became so well-established in the U.S.
Initially, only military personnel were allowed access to this life-saving material. Eventually, prior to the end of World-War II, penicillin was made available to the general public.
Luckily for me, (this is written by Prof. John Brown, from Kansas State University) on my death-bed suffering from measles (a virus) and from bacterial pneumonia as a child in 1944, I was allowed to have penicillin because my father was in the Army - saved my life. Thank you, Drs Fleming, Florey, and Chain for your wonderful science.
(You may wish to look at the action of this antibiotic. Please see Jim Sullivan's Cells Alive! <http://www.cellsalive.com> information and look at the effect penicillin has on a dividing bacterium: )
Copyright John C. Brown, 1995
All of the "Feature Articles," and the articles in "What the Heck is...???" and in "General Interest" were written by me, and therefore, any mistakes are mine, alone. I have tried to be as accurate as possible within the limits of providing the information in a "reader-friendly" format. Therefore, please forgive any latitude I have taken with the pure science discussed. With these caveats in mind: in keeping with the spirit of the "Web" and Internet, and the fact that this institution has been established for, and is devoted to, learning, all of the articles on these Pages are for anyone's use, as long as the use is for non-profit only, and this statement accompanies any copies.
Dr Jack Brown is a professor of molecular biosciences at Kansas State University; and has a neat web site about all kinds of interesting disease, bacterial, and viral subjects of interest. He writes for the general public in these articles...all of which begin with "What the heck is...."
His web site: http://people.ku.edu/~jbrown/bugs.html
History of Antibiotics:
Another Version
Although for centuries preparations derived from living matter were applied to wounds to destroy infection, the fact that a microorganism is capable of destroying one of another species was not established until the latter half of the 19th cent. when Pasteur noted the antagonistic effect of other bacteria on the anthrax organism and pointed out that this action might be put to therapeutic use.
Meanwhile the German chemist Paul Ehrlich developed the idea of selective toxicity: that certain chemicals that would be toxic to some organisms, e.g., infectious bacteria, would be harmless to other organisms, e.g., humans.
In 1928, Sir Alexander Fleming, a Scottish biologist, observed that Penicillium notatum, a common mold, had destroyed staphylococcus bacteria in culture, and in 1939 the American microbiologist René Dubos demonstrated that a soil bacterium was capable of decomposing the starchlike capsule of the pneumococcus bacterium, without which the pneumococcus is harmless and does not cause pneumonia. Dubos then found in the soil a microbe, Bacillus brevis, from which he obtained a product, tyrothricin, that was highly toxic to a wide range of bacteria.
Tyrothricin, a mixture of the two peptides gramicidin and tyrocidine, was also found to be toxic to red blood and reproductive cells in humans but could be used to good effect when applied as an ointment on body surfaces. Penicillin was finally isolated in 1939, and in 1944 Selman Waksman and Albert Schatz, American microbiologists, isolated streptomycin and a number of other antibiotics from Streptomyces griseus.
Someone Else who deserves recognition, but didn't get much seeing as he was on the losing side of the war and worked for the infamous Farben Industry Labs:
Domagk, Gerhard
1895-1964, German chemist and pathologist. A teacher successively at the universities of Greifswald and Münster, he became (1927) director of research at the I. G. Farbenindustrie laboratory at Wuppertal. Because of a Nazi decree he was obliged to decline the 1939 Nobel Prize in Physiology or Medicine. In 1947 he received a gold medal in lieu of the prize money. The award was made for his discovery of the efficacy of prontosil, the forerunner of the sulfa drugs, in treating streptococcal infections.
A Brief History of Medicine
(This material is right out of my online encyclopedia, but quite interesting)
The History of Medicine in Ancient Times
Prehistoric skulls found in Europe and South America indicate that Neolithic man was already able to trephine, or remove disks of bone from, the skull successfully, but whether this delicate operation was performed to release evil spirits or as a surgical procedure is not known.
Empirical medicine developed in ancient Egypt, and involved the use of many potent drugs still in use today, such as castor oil, senna, opium, colchicine, and mercury.
In spite of their skill in embalming, however, the Egyptians had little knowledge of anatomy.
In Sumerian medicine the Laws of Hammurabi established the first known code of medical ethics, and laid down a fee schedule for specific surgical procedures.
In ancient Babylonia, every man considered himself a physician and, according to Herodotus, gave advice freely to the sick man who was willing to exhibit himself to passersby in the public square.
The Mosaic Code of the Hebrews indicated concerns with social hygiene and prevention of disease by dietary restrictions and sanitary measures.
Although ancient Chinese medicine was also influenced adversely by the awe felt for the sanctity of the human body, the Nei Ching, attributed to the emperor Huang-Ti (2698-2598 B.C.), contains a reference to a theory of the circulation of the blood and the vital function of the heart that suggests familiarity with anatomy.
In addition, accurate location of the proper points for the traditional Chinese practice of acupuncture implies some familiarity with the nervous and vascular systems. The Chinese pharmacopoeia was the most extensive of all the older civilizations.
The Hindus seem to have been familiar with many surgical procedures, demonstrating skill in such techniques as nose reconstruction (rhinoplasty) and cutting for removal of bladder stones.
In Greek medicine the impetus for the rational approach came largely from the speculations of the pre-Socratic philosophers and such philosopher-scientists as Pythagoras, Democritus, and Empedocles.
Hippocrates, the father of Western medicine, taught the prevention of disease through a regimen of diet and exercise; he emphasized careful observation of the patient, the recuperative powers of nature, and a high standard of ethical conduct, as incorporated in the Hippocratic Oath.
By the 4th cent. B.C., Aristotle had already stimulated interest in anatomy by his dissections of animals, and work in the 3d cent. B.C. on human anatomy and physiology was of such high quality that it was not equaled for fifteen hundred years.
The Romans advanced public health and sanitation through the construction of aqueducts, baths, sewers, and hospitals. The encyclopedic writings of Galen constitute a final synthesis of the medicine of the ancient world. Revered by Arabic and Western physicians alike, his concepts stood virtually unchallenged until the 16th cent. Unfortunately, his prolific researches on anatomy and physiology were not invariably accurate, and reliance on them impeded subsequent progress in anatomy.
The Middle Ages
With the destruction or neglect of the Roman sanitary facilities, there followed a series of local epidemics that culminated many centuries later in the great plague of the 14th cent. known as the Black Death.
During the Middle Ages certain monastic libraries, notably those at Monte Cassino, Bobbio, and St. Gall, preserved a few ancient medical manuscripts, and Arab and Jewish physicians such as Avicenna and Maimonides continued medical investigation.
The first real light on modern medicine in Europe came with the translation of many writings from the Arabic at Salerno, Italy, and through a continuing trade and cultural exchange with Byzantium.
By the 13th cent. there were flourishing medical schools at Montpellier, Paris, Bologna and Padua, the latter being the site of production of the first accurate books on human anatomy. At Padua, Vesalius proved that Galen had made anatomical mistakes. Prominent among those who pursued the new interest in experimental medicine were Paracelsus , Ambroise Paré , and Fabricius , who discovered the valves of the veins.
The Birth of Modern Medicine
In the 17th cent. William Harvey , using careful experimental methods, demonstrated the circulation of the blood, a concept that met with considerable early resistance.
The introduction of quinine marked a triumph over malaria, one of the oldest plagues of mankind. The invention of the compound microscope led to the discovery of minute forms of life, and the discovery of the capillary system of the blood filled the final gap in Harvey's explanation of blood circulation.
In the 18th cent. the heart drug digitalis was introduced, scurvy was controlled, surgery was transformed into an experimental science, and reforms were instituted in mental institutions.
In addition, Edward Jenner introduced vaccination to prevent smallpox, laying the groundwork for the science of immunization.
The 19th cent. saw the beginnings of modern medicine when Pasteur , Koch , Ehrlich and Semmelweis proved the relationships between germs and disease.
Other invaluable developments included the use of disinfection and the consequent improvement in medical, particularly obstetrical, care; the use of inoculation; the introduction of anesthetics in surgery ; and a revival of better public health and sanitary measures. A significant decline in maternal and infant mortality followed.
Modern Medicine Medicine in the 20th cent. received its impetus from Gerhard Domagk who discovered the first antibiotic, sulfanilamide, and the groundbreaking advancements in the use of penicillin .
Further progress has been characterized by the rise of chemotherapy , especially the use of new antibiotics ; increased understanding of the mechanisms of the immune system and the increased prophylactic use of vaccination; utilization of knowledge of the endocrine system to treat diseases resulting from hormone imbalance, such as the use of insulin to treat diabetes; and increased understanding of nutrition and the role of vitamins in health.
In Mar., 1953, at Cambridge Univ., England, Francis Crick , age 35, and James Watson, age 24, announced "We have discovered the secret of life."
Indeed, they had unraveled the chemical structure of the fundamental molecule of heredity, deoxyribonucleic acid (DNA), giving science and medicine the basis for molecular genetics and leading to a continuing revolution in modern medicine.
Much medical research is now directed toward such problems as cancer , heart disease, AIDS, reemerging infectious diseases such as tuberculosis and dengue fever , and organ transplantation.
Currently, the largest worldwide study is the Human Genome Project , which will identify all hereditary traits and body functions controlled by specific areas on the chromosomes.
Gene therapy , the replacement of faulty genes, offers possible abatement of hereditary diseases. Genetic engineering has led to the development of important pharmaceutical products and the use of monoclonal antibodies , offering promising new approaches to cancer treatment. The discovery of growth factors has opened up the possibility of growth and regeneration of nerve tissues.
With the surge of general and specialized medical knowledge, the educational requirements of the medical profession have increased. In addition to the four-year medical course and the general hospital internship required almost everywhere, additional years of study in a specialized field are usually required. Similar progress and increased requirements in education are reflected in ancillary professions such as nursing.
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Please support our sponsors...we get a commission when you do...all of which goes to help feed, fix-up,
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Thanks.
A Tribute to Vannevar Bush
1890-1974, American electrical engineer and physicist, b. Everett, Mass., grad. Tufts College (B.S., 1913). He went to Massachusetts Institute of Technology (MIT) in 1919; there he was professor (1923-32) and vice president and dean of engineering (1932-38). During this period he devised a network analyzer to simulate the performance of large electrical networks. He is best known for his design of the differential analyzer, an analog computer that could solve differential equations with as many as 18 independent variables. From 1939 until 1955 he was president of the Carnegie Institution. From 1941 to 1945 he was also the director of the U.S. Office of Scientific Research and Development, where he administered the U.S. war effort to utilize and advance military technology. He directed such programs as the development of the first atomic bomb, the perfection of radar, and the mass production of sulfa drugs and penicillin.
In 1955 he returned to MIT, retiring in 1971. Bush wrote Endless Horizons (1975) and Modern Arms and Free Men (1985).
Money, Money, Money:
A lesson for our citizens in the United States of America
Take out a one dollar bill and look at it.
The one dollar bill you're
looking at first came off the presses in 1957 in its present design.
This so called paper money is in fact a cotton and linen blend, with red and blue minute silk fibers running through it.
It is actually material.
We've all washed it without it falling apart.
A special blend of ink is used, the contents of which we will never know.
It is overprinted with symbols and then it is starched to make it water resistant and pressed to give it that nice crisp look.
If you look on the front of the bill, you will see the United States
Treasury Seal.
On the top you will see the scales for the balance - a balanced budget.
In the center you have a carpenter's T-square, a tool used for an even
cut.
Underneath is the Key to the United States Treasury.
That's all pretty easy to figure out, but what is on the back of that
dollar
bill is something we should all know.
If you turn the bill over, you will see two circles.
Both circles, together, comprise the Great Seal of the United States.
The First Continental Congress requested that Benjamin Franklin and a group of men come up with a Seal.
It took them four years to accomplish this task and another two years to get it approved.
If you look at the left hand circle, you will see a Pyramid.
Notice the face is lighted and the western side is dark.
This country was just beginning.
We had not begun to explore the West or decided what we could do for Western Civilization.
The Pyramid is uncapped, again signifying that we were not even close to
being finished.
Inside the capstone you have the all seeing eye, and ancient symbol for
divinity.
It was Franklin's belief that one man couldn't do it alone, but a group of men, with the help of God, could do anything.
"IN GOD WE TRUST" is on this currency.
The Latin above the pyramid, ANNUIT COEPTIS, means
"God has favored our undertaking."
The Latin below the pyramid, NOVUS ORDO SECLORUM, means "a new order has
begun."
At the base of the pyramid is the Roman Numeral for 1776.
If you look at the right hand circle, and check it carefully, you will
learn that it is on every National Cemetery in the United States.
It is also on the Parade of Flags Walkway at the Bushnell, Florida
National
Cemetery and is the centerpiece of most heroes' monuments.
Slightly modified, it is the seal of the President of the United States and it is always visible whenever he speaks, yet no one knows what the symbols mean.
The Bald Eagle was selected as a symbol for victory for two reasons:
First, he is not afraid of a storm; he is strong and he is smart enough to soar above it.
Secondly, he wears no material crown.
We had just broken from the King of England.
Also, notice the shield is unsupported.
This country can now stand on its own.
At the top of that shield you have a white bar signifying congress, a
unifying factor.
We were coming together as one nation.
In the Eagle's beak you will read, "E PLURIBUS UNUM," meaning "one nation from many people."
Above the Eagle you have thirteen stars representing the thirteen original colonies, and any clouds of misunderstanding rolling away.
Again, we were coming together as one.
Notice what the Eagle holds in his talons.
He holds an olive branch and arrows.
This country wants peace, but we will never be afraid to fight to preserve peace.
The Eagle always wants to face the olive branch, but in time of war, his
gaze turns toward the arrows.
Disclaimers
About diagnosing and treating your own pet: That's not the intention of my comments in the treatment sections of this web site and I think you would be foolish in most cases to treat your pets based on what you read on my site. In fact, I hope it will become obvious in the treatment discussion just how complex coming up with a diagnosis and treatment plan can be.
In addition to the educational background that veterinarians have, it takes seeing 20 plus cases a day for years to get good at figuring out what's wrong and what will be needed to get the case under control.
The intention of the treatment section is to give you an idea of what to expect if your pet has a problem and even better; to give you an outline of the main points you have discussed or considered with me or your vet during the exam.
Another intention of the treatment comments is to instill in you, the pet owner, the idea that while many cases are straight forward and respond well to our chosen initial treatment, there are lots of exceptions...not because the veterinary work was shoddy...but because the nature of curing disease depends on so many factors.
All my treatment comments include options for a reason; there is no one set best way to treat every case. And all my comments leave open the possible need of referring to another vet, usually a specialist, because no vet has all the answers or equipment or expertise needed for every case.
About my treatment recommendations: They are based on my 16 plus years of clinical practice and have been very successful. Most of my treatment choices are standard among my peers but when I stray from these standards I mention that such and such treatment is experimental or not universally accepted or differs from normal standard western veterinary medicine. So no surprises.
We veterinarians differ in our approach to cases. It is becoming more common now, for example, to do lots more laboratory testing and radiographs, almost routinely, before starting treatment. This philosophy is patterned after western human medicine and has the multiple advantages of confirming and better defining the suspected diagnosis, of making more certain that you didn't miss something (lots of legal implications here) and from a practical standpoint, doing tests in volume helps to pay for having the equipment needed to perform such tests. Most modern lab equipment is too expensive to be feasible if it were only used for the occasional patient.
Many vets, me included, still avoid doing a lot of lab work and x-rays if we feel we can successfully treat the patient without them in order to save money for the client. We would make more money and make less mistakes if we recommended more lab work, but we often go the less expensive route for the honest reason that it's how we would treat our own pet in a similar situation.
It all depends on the case. Many cases warrant an expensive* workup right from the start, and other cases that seem simple at first surprise us, making lab work, etc a good idea if the case isn't responding as hoped.
At any rate, know that different veterinarians approach and treat similar cases differently...just like in human medicine...and my approach may not be the best one for your pet.
* a little note about the word expensive. It's all relative; compare most any medical expense in veterinary medicine to it's human hospital equivalent and we're usually talking a great deal. We vets tend to be very efficient.
About mistakes on this site: Give me a break. I stay up to 2 am each evening writing these things as an aid to you. I will correct mistakes as they are found, and all the treatment comments are just that; comments and opinions for discussion in hopes of improving your understanding and getting better care for you pet.
If you have found an error, or want to add or correct or expound on any of my comments...especially if you're a veterinarian...please eMail me:
foxnest@metacrawler.com
It would be great if you'd like to add a treatment article for any of these pages. I will gladly give you credit and link to your site if you wish.
Thanks, Roger Ross DVM
PS Please don't expect me to answer all the eMails I am getting asking me how to treat your pet or to make comments on the treatment your vet recommends. The information on these pages is general in nature and I hope very helpful to your understanding, but to give specific medical advice about a specific patient requires a careful exam, the collection of information and laboratory data, monitoring of the patient and modification of the treatment depending on results.
It's also legally dangerous for me to answer specific medical questions without taking the time and care to evaluate the patient...even assuming I had the time... Once a veterinarian gives out medical advice, he or she may be held legally responsible for the results if things go wrong. And things do go wrong. Life can be fragile. Because we are aware of all the possible things that might go wrong, we vets tend not to spout off until we take the time to be reasonably sure we know what the situation is and that we have it under control. So, If you want professional answers about an actual patient...you'll need to go to your veterinarian and pay their fee...usually well worth it!
About this subject of getting professional answers; be careful. You can have alot of confidence in almost all vets. It's a rare vet who can get through our rigorous training without being highly competent...and fewer still who survive in practice long being careless. On the other hand, you surely must realize that there's a lot of whacky and ineffective animal medical care advice out there given by groomers, trainers, breeders, old flower children, new agers, psychics, and self appointed guru's.
At any rate, I will probably be unable to take the time to answer eMails about specific medical questions, personal questions, or respond to some of the hate mail I'm getting about my opinions. God Bless, Roger Ross DVM
