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By MEGAN TREMELLING, DVM, LVS

This summer, a Wisconsin woman died of an infection caused by a bacterium called Capnocytophaga canimorsus, and a Wisconsin man suffered serious illness requiring multiple amputations from the same organism. The infections are believed to be derived from contact with family pet dogs. This is scary stuff for those of us who share our lives with dogs, but there is no need to panic about Capnocytophaga.

Capnocytophaga species are found in the mouths of healthy dogs, cats, and humans. Normally it does no harm, but under certain circumstances, it can cause disease. Studies estimate that up to 74 percent of dogs and up to 57 percent of cats have Capnocytophaga living in their oral cavities. In short, if you have a dog, odds are very good that it carries Capnocytophaga.

In spite of how common Capnocytophaga is, however, serious infections are exceedingly rare. Nobody knows exactly how many cases occur, but the Centers for Disease Control and Prevention (CDC) received only 12 case reports in 2017, and only about 200 cases have been reported worldwide since this type of bacteria was first identified in 1976.

Capnocytophaga infections can be transmitted by bites from dogs or cats, or through close contact with an animal, especially contact with its saliva. Since humans also frequently carry Capnocytophaga, it is possible to develop an infection without any animal exposure.

Most of the time, Capnocytophaga is not your main concern after a dog or cat bite. Other bacteria, such as Pasteurella, Streptococcus, and Staphylococcus, cause many more infections. Rabies is uncommon in the United States but is so deadly that any possibility must be taken very seriously. Lastly, deep puncture wounds of any origin can result in tetanus.

When Capnocytophaga does cause problems, they can vary widely. Local cellulitis (tissue swelling, redness, and pain) is the most common finding associated with bite wounds contaminated by Capnocytophaga. In more serious cases, the bacteria can spread to other parts of the body such as the heart, brain, or joints. When the infection affects the whole body in a condition called sepsis, there can be long-term effects from infection, including gangrene that necessitates amputations; heart attacks; or kidney failure. About 3 in 10 people who develop sepsis due to Capnocytophaga will die.

Most people who are exposed to dog saliva don’t get Capnocytophaga infections because their immune systems protect them. However, there are factors that can affect your immune system’s ability to keep you safe. One of the most serious risk factors is having had your spleen removed as a result of an injury or illness. Other risk factors include alcohol abuse, old age, or immune compromise due to disease such as cancer, diabetes, or HIV, or taking certain medications such as chemotherapy or glucocorticoids. Some people do get sick with no known risk factors.

Capnocytophaga infections are hard to test for. The bacteria are very difficult to grow in a lab. Fortunately, new technologies such as PCR amplification and gene sequencing are becoming increasingly useful for identifying challenging organisms like Capnocytophaga. The good news is that Capnocytophaga can be treated with common antibiotics, and so far antibiotic resistance isn’t a big problem. However, treatment must be started quickly, without waiting for a lab to confirm the infection.

There are ways to reduce your risk of a Capnocytophaga infection. Don’t let your pets lick faces, wounds, or irritated skin, and wash with soap and water after handling your animals. Minor bite wounds should be washed thoroughly with soap and water. See a health care provider if the wound is deep or serious; if it becomes red, painful, warm, or swollen; or if you feel feverish or weak. You should also see a doctor if the dog was acting strangely or is not known to be vaccinated against rabies. Most people who are going to become ill with Capnocytophaga will do so within 3 to 5 days after exposure, but it can take as little as a day. If you have any risk factors such as immune compromise, you should see your doctor right away for any bite wound that breaks skin, even if you don’t feel sick.

By MEGAN TREMELLING, DVM, LVS

In January, someone tried to take a peacock on a United Airlines flight, claiming it was an emotional support animal (ESA). Last June, a 50-pound dog that was traveling on Delta as an ESA badly mauled the face of another passenger. So much for the friendly skies.

Don’t get me wrong here. I’m not opposed to the idea of ESAs. Animals can be an incredible balm to the human psyche even when it is in perfect working order. Mental health is extremely complex, and if somebody needs their dog with them to be able to manage, I’m not going to criticize. Fortunately, the TSA views ESAs as aids that allow people to live their lives, going a step beyond the job of “pet,” and so ESAs are allowed in airports and airplanes. Traveling with a disability can be challenging enough without the airlines placing undue burdens on the people who need these animals to get by.

On the other hand, when an airplane cabin starts to resemble a petting zoo, and passengers are being taken away by ambulance, clearly there is a flaw with the system. A big part of the problem, of course, is the irritating phenomenon of people pretending their dogs are ESAs, or even service animals, when they really aren’t.

Why would someone pretend to have an ESA or service dog, instead of admitting that their dog is a pet? For one thing, traveling with a pet can be challenging. People are understandably wary of putting their pets in cargo, given some tragedies that have occurred there. Whether in cargo or in the cabin, there are fees to be paid, and the airline may turn your pet away if there are already too many animals on the flight. ESAs and service dogs, however, sometimes travel for free, and are more likely to be accommodated in the cabin regardless of the number of animals on the airplane or the size and weight of the dog.

This does not change the fact that pretending your pet is an ESA is clearly unethical in all cases, and is criminal in some areas. There is quite simply a limit to the number of animals that can fit on a given airplane before things get disruptive. Like disabled parking permits, those spaces should be reserved for people who actually need them.

In an attempt to reduce abuse of the system, some airlines have begun to use more stringent restrictions on ESAs. Delta, for example, has quite an extensive list of animal species that are not permitted on board. United now requires customers with ESAs to bring “a veterinary health form documenting the health and vaccination records for the animal as well as confirming that the animal has been trained to behave properly in a public setting.”

Owners are notoriously bad at assessing their own animals’ behavior, so I can see why the airlines want to get a third party to vouch for the dog, but many veterinarians are wary of going on record stating that their patients have been trained to behave properly. For one thing, even a dog that is well-mannered under ordinary circumstances may find the conditions on an airplane to be a little much. Let’s face it, after standing in line at security, navigating the hubbub of the airport, and then getting squeezed for hours into a cramped space that makes deafening noises and ear-popping pressure changes, even the humans are just about ready to bite somebody. There is no way that I or any other veterinarian can tell whether a dog that behaves nicely in the clinic will continue to do so in flight.

People who genuinely need ESAs will be the ones to suffer if they can’t produce the paperwork the airlines now expect. Even service dogs from an accredited training program, which are expertly-trained to tolerate quite challenging conditions without causing trouble, may find it hard to get on board.

It remains to be seen how to best balance the needs of people with disabilities who rely on their animals to function and the other passengers’ basic expectation of reasonable safety. Veterinarians, representatives of the air travel industry, and disability advocates are attempting to work together to find a way to ensure that genuine service dogs and ESAs are accommodated without putting other passengers at risk. But one thing is clear: pretending your pet is a service animal is not okay.

By MEGAN TREMELLING, DVM, LVS

To some people, leaving your dog at the veterinary hospital for any reason sounds harsh, like leaving a child at one of those ghastly orphanages in Dickens books. There’s no doubt that most dogs would rather be in their own homes, but we do our best to make them feel at home with us. So what are the accommodations really like at the hospital?

A comfortable bed is step one, and we have bedding in a variety of thickness and layering options. Some dogs want to have enough blankets to burrow under. Orthopedic mattresses are a great thing for older dogs whose joints get creaky. There are a few dogs that simply cannot tolerate being in a kennel at all, and though I strongly recommend teaching all dogs to accept a kennel for this reason, we have worked out ways to confine the kennel-phobic without them feeling trapped.

Many owners bring a blanket or article of clothing that smells like home. I think this is a great idea for a pet that is wary of novelty. Once a pet has settled in, of course, their own smell is on their bedding. Most dogs are quite willing to go back into their kennels after they’ve been out for tests or treatment; they recognize it as their own safe space.

Nobody wants to sit in bed all day, even if they’re sick, so all dogs are walked several times per day if their condition allows. There are a few small dogs that are trained to use pee pads, but even those are given the opportunity to take a little exercise. (Exception: When I had a 5lb puppy hospitalized overnight and it was -5°F, I did not take the little mite outside; she would have frozen solid.)

Boredom can be a problem even with pets that are ill enough to be hospitalized. Visits from the owner help to pass the time. We keep a supply of stuffed animals around, carefully chosen for safe construction, and provide them to any patient who looks like they might want something to snuggle. If snuggling turns to chewing, unfortunately, the dog loses stuffy privileges, but we can resort to treat-stuffed Kongs if the patient’s condition permits.

Speaking of food, the phrase “hospital food” takes on a very different meaning when you’re talking about the animal hospital. It isn’t bland, boring, cafeteria-style stuff like you might see in an old-fashioned human hospital. Since many of our patients are feeling too sick to eat properly, we stock a variety of delicacies to tempt feeble appetites, along with several therapeutic diets for those that are ready to take more substantial meals.

Some of the dogs that visit us are really excited to see that there are other dogs on the premises. They would love to make friends with everyone. Unfortunately, for safety reasons, we can’t allow playtime among the patients, but if they want human friends, they’re in luck. Everyone who works at our clinic loves dogs madly. No matter how tired or grumpy we might be at the beginning of our shifts, the sweet faces of our patients help us to focus on the positive. It’s all we can do to get our work done when there are so many ears to be scratched and tummies to be rubbed. When things are slow at the office… well, there may or may not have been a few patients who spent part of their hospitalization sleeping on my lap in the office. I’m not saying.

Some people go a little bit overboard with the comforts they provide their pets at home. I’m pretty sure no dog ever suffered for lack of a $30,000 wedding chapel doghouse (for, of course, dog weddings), a Marie-Antoinette style brocade dog bed (complete with ostrich plumes), or a microvelvet Chesterfield dog sofa (with nailhead trim, naturally). The accommodations at the veterinary hospital will be a bit more spartan than that. (For one thing, everything we use is 100 percent machine washable). But, for all that, I think we do all right at helping our patients to feel at home.

By MEGAN TREMELLING, DVM, LVS

Like most veterinarians, I genuinely love animals, but the sad fact is that not all of my patients love me back. For every pet that greets me with a wagging tail and happy kisses, I get at least one who gives me side-eye and a stony expression. I can’t blame them, of course. I invade the personal space of every one of my patients when I do a physical exam, and further indignities and discomforts come with almost everything I do. Some patients take it all cheerfully, others tolerate it, and then there are those who put a furry foot down and say, “No way.”

This is where muzzles come in. Some dog owners find muzzles scary. They can look like torture devices, although they don’t actually hurt the dog, and it is possible to buy cute ones. Dogs dislike the muzzle, and owners find this upsetting. “Why do you need to muzzle my dog?” they sometimes ask. “He’s not going to bite you! What kind of veterinarian is afraid of dogs?”

Well, it’s like this. I’m not afraid of dogs; if I were, I couldn’t do my job. I do, however, have a certain respect for what their teeth can do. It’s born of seeing many a dog bite injury in my career: many of them on my patients, some on my co-workers, and a few on myself. Our furry best friends come with teeth that were designed to cut and crush flesh, and they’re pretty good at it. Big dogs of course can be more dangerous, but size doesn’t always matter. Almost any dog can, if motivated, give me an injury that will put me out of work for months.

What are the odds that any particular dog will bite? Unfortunately, that dog’s owner isn’t always the best person to make that prediction. Dogs that are angels at home with their people sometimes make bad choices when they’re in a strange place, surrounded by strangers, feeling threatened, or cornered or in pain. Some dogs will even bite their owners when they’re at the vet’s office. In this game, there are no bonus points for doing things the reckless way so I prefer to err on the side of safety.

Placing a muzzle on an uncooperative dog can actually make the process of providing veterinary care easier on the patient. It isn’t immediately obvious that this would be true, but it is true. Some dogs, when muzzled, just freeze. You have seen this phenomenon in action if you have ever seen a rowdy puppy annoying an older dog until the adult has to give the pup a correction; they do this by taking hold of the pup’s muzzle to make it stop misbehaving. In the same way, some dogs, when muzzled, seem to get the message that it’s time to stop snapping and struggling. That means I can do my job quickly and thoroughly rather than having a prolonged wrestling match that’s far more upsetting to the patient than whatever it was I was trying to do in the first place. Of course, the process works best if the dog is muzzle-trained, and I encourage every dog owner to do so.

But even or especially in patients that won’t give up resisting, a muzzle ultimately reduces the risk of anyone getting bitten. And while I selfishly want to keep my skin intact, I also want to avoid bites for the dog’s and the owner’s sake. Wisconsin state law is quite strict on the subject of dog bites. Any medical care provider who treats a person that was bitten by a dog is legally required to report the bite to the authorities, and the dog is then subject to rabies quarantine. This is expensive for the dog’s owner and means extra visits to the veterinarian’s office for the dog that didn’t enjoy going in the first place. If the dog dies or is euthanized for any reason before the end of the quarantine period, its body must be tested for rabies, a process that can also be expensive for the owner.

Of course muzzles aren’t the only tool I have to keep teeth off skin. I rely on my expert staff to distract and safely restrain pets, and I use all my training and experience to make veterinary care as painless and reassuring as possible for the patients. But there are times when a muzzle is the right choice, and then I don’t hesitate. It’s for everybody’s protection.