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The following Q&A is a transcript of a recent Dogasaur Vet customer inquiry and veterinarian response. The exchange took place on a Friday night after normal vet office hours, and covers a concerned pet owner who’s dog was recently attacked by a larger dog.
Pet Owner Question: I have a pug, 3 yrs old, female. For the last week, when she yawns, her jaw doesn’t open all the way. It’ll open about halfway and that’s it. She’s eating normally, drinking normally, chewing and playing with her toys normally and is still lively with our other dog, doesn’t seem to be in pain, but my concern is with an incident that took place a few days before I noticed this issue. She was attacked by a Munsterlander, picked up by the back of the scruff and tossed to the ground - no injuries, was perfectly fine, thank god- but I noticed this a few days later with her jaw. I’m not sure if its related to the incident or not, but wanted to get an opinion here before going to the vet and being gouged with x-ray fees and what not, if its a common problem.
Follow-up questions from veterinarian:
Hi,
I am so sorry to hear about what happened to Cindi; how horrible! I know you mentioned that she is eating/drinking normally and not exhibiting any pain, but I wanted to ask a few specific questions.
- Is she dropping any food when she eats or eating more slowly?
- As far as the pain–have you touched her jaw area and if so, did she respond normally?
- Have you been able to do a thorough physical exam to make sure there are no bite or puncture wounds?
I do think this is probably related to the incident. I am working on your response. If you can answer those questions, it will help me.
Best regards,
Dr. Laci
Pet owner’s response: She is still eating at her normal pace - which is gobbling up quickly and making a mess in the process LOL. We’ve touched her jaw several times, and put a bit of pressure on the area to see if she feels any pain and she doesn’t react abnormally - in fact I think she likes it and thinks she’s getting a facial massage. Definitely no pain there. And we did do a check over after the incident - no bites, or puncture wounds.
Veterinarian’s answer:
Hi,
Again, I am so sorry to hear about Cindi being made into a chew toy. I have seen many small dogs that have their skin completely torn off from their neck half way down their back so praise the Lord that didn’t happen.
A do have a couple of possible diagnoses for you, and I want to be as thorough as possible with you.
- Tetanus–obviously, this requires puncture wounds. The incubation period varies from one to several weeks but usually averages 10-14 days, making this less likely for Cindi. Localized stiffness, often involving the chewing muscles and muscles of the neck, the hind limbs, and the region of the infected wound, is seen first; general stiffness becomes pronounced ~1 day later, and tonic spasms become evident. Because of their high resistance to tetanus toxin, dogs often have a long incubation period and frequently develop localized tetanus; however, generalized tetanus does develop. I just mention this in case you notice her stiffness spreading.
- Masticatory myostis–inflammation of the muscles used for chewing. Diagnosing requires antibody titers and/or a biopsy and x-rays to rule out other things. Also, treatment is a long course of steroids.
- Muscle soreness from the accident–most likely, especially after hearing that she seems to like the facial massage. It would make sense as it is like getting a massage after a rough workout.
- TMJ–inflammation of where the jaw is connected with the skull. This could occur after trauma. It is a broad umbrella term and can include nerve damage, such as what would cause her to drop food from her mouth or lack control over her tongue, to damage to the bursa in that area. Treatment would be vary depending upon the extent of damage. X-rays would really be needed here.
- Off chance that is something unrelated to the incident–tumor or other mass that is restricting the angle at which she can open her mouth. Less likely, but worth mentioning so we don’t jinx ourselves.
If you were to go to the vet…
Physical exam is obviously where the vet would start. I must throw it out there that I have had many pet owners think there were no bite wounds but after a thorough exam and clippers to trim the affected area, we often found bite wounds. If Cindi is not in pain, I would examine her as closely as possible for any puncture wounds or scabs around her neck. If you can’t do this, either a vet or a groomer could assist. Of course a vet could do an exam and manipulate her neck and watch for pain, so this is ideal, but I know everyone has a budget.
Based on the physical exam a vet may recommend x-rays just like you mentioned. The catch would be they would also recommend heavy sedation/anesthesia, as the dog must be very still to get to x-rays of the scull and neck area. Also, sedation would be required to fully manipulate her jaw and see how far she can open it if she is indeed in pain. A further catch is that she is a brachycephalic breed (short-headed and this can cause respiratory problems). In general, they are at a slightly higher risk for adverse anesthesia events–or at least can be more difficult to intubate. If the mobility of her jaw is reduced, depending upon how much of course, I would really think twice as her vet, about sedating her. Any time you sedate an animal, there is a risk. I don’t know how many thousands of animals I have had under anesthesia and luckily I have never had an anesthesia complication that I wasn’t able to correct, but being able to intubate the pet in case of complications is often how you fix the problem. If her jaw mobility was compromised to the point where I was not confident that I could safely intubate her, I would not sedate her. I would evaluate the need for the sedation, and I would have a serious conversation with the pet parent about risk vs. benefit.
Another thing the vet might recommend is a blood test called a complete blood cell count to look for evidence of an increase in WBC. If there were any puncture wounds, an increase in WBC could mean Cindi has a systemic infection resulting from the incident. Yet another blood test that is part of the chemistry panel is a creatinine kinase levels (CK). This checks for muscle damage. It is not an incredibly accurate test, but I think there is a decent chance that Cindi’s CK level would be elevated.
When I evaluate treatment plans/course of actions for pet parents and their pets, I like to ask myself, “will the outcome of this test change my course of action?” If it doesn’t, then all it really does is give me more information, which is good, but every pet parent has a preference for how they like their pet’s healthcare to be handled. Some people like to know as much as possible, with money being no object, and others it doesn’t make a difference to. As far as the CK test, I don’t know that it really changes the course of action. Yes, it may indeed tell us that Cindi is in pain, but I suspect she already is, if only slightly. An elevated WBC would be cause for antibiotics. But if there were NO bite wounds, it is highly unlikely she would get a systemic infection from the incident.
Be careful when you examine her–even your own dog may bite you if you do something that is painful, just out of instinct.
What you do is up to you. I think it is completely reasonable to expect her to be in pain after being picked up by the back of the neck and slung around. It is very likely that would stress and/or tear her muscles. The good thing about a vet visit is they could prescribe her some pain medications. They may be reluctant to prescribe what is called NSAIDs (non-steroidal anti-inflammatory drugs) without doing blood work first, as they can be contraindicated if the patient has liver or reduced kidney function, but that depends upon your vet.
If you decide to go to the vet and you want pain meds, you don’t have to buy them from your vet. You can ask your vet to provide you a prescription to purchase them elsewhere. Target or Walmart or other large pharmacies such as Giant have what is called the $4 prescription program. This is in the USA; I am unsure about other countries. You can get well over a month’s supply of pain meds for $4. A very safe drug I would consider if I were her vet would be tramadol. There are NSAIDs on the list as well, such as peroxicam and meloxicam. You can bring the names of these to you vet if you decide to go. Interestingly enough, there is a bill before Congress right now for your vet to prescribe you with a script for no fee (some vets charge $7-15 for the script still), as more and more pet owners request to purchase their pet’s meds elsewhere than the vet.
I am glad to hear you found no bite or puncture wounds. Based upon her history, it does sound like she is likely sore after the incident. If you decide not to go to the vet, keep a close eye on her to make sure she is improving and not worsening. Signs to watch out for: decreased appetite, changes in eating (slower, dropping food), lack of tongue control, drooling, shivering, lethargy, pain, decreasing angle to open her mouth, and the systemic changes I mentioned with tetanus. Also, if she seems warm this could indicate an infection. You can buy an ear thermometer or a rectal thermometer (never a bad idea). Dog’s temperatures are usually around 102.5 degrees. FYI, if your dog has stool in their rectum it lowers the temperature, and some ear thermometers are less accurate. I just recently purchased a new ear one for $20 and it has been very accurate so far.
Please let me know if you have any other questions. It sounds like you are taking great care of Cindi, and she is lucky to have you. Hope she doesn’t have any more run-ins with the neighborhood bully! I can’t imagine how terrifying that must have been for both you and her.
Best regards and much TLC to Cindi,
Dr. Laci
Pet owner’s close: Thank you for your advice - I think my husband and I will take her to her vet if she hasn’t improved over the weekend and just see what they say. If it turns out to be something directly related to the incident, then I’d like to know because its my brother in laws dog, who has a history of aggression and I wouldn’t mind having that issue taken care of (and also, have them cover my vet bills! lol)…want to make sure she doesn’t have anything serious going on. Thank you so much for your help, much appreciated!
If you have a health concern about your pet, or if you’re not sure if you need to make an office visit to your vet, then try our Dogasaur Vet service. You’ll be chatting online in minutes with a licensed veterinarian whose advice may bring you some peace of mind about your dog’s condition.
Pug photo courtesy of J. Spaulding.
Tags: dogasaur vet, dog attack, online vet, pug, vet
Posted in Dogasaur Masters | 184 Comments »
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