The Coneheads

The official symbol of veterinary medicine is the letter V superimposed on the “Rod of Asclepius” (you know, that snake twining around an upright stick). The unofficial symbol, however, is the “Cone of Shame”. Before I go on to discuss the cone, I want to say a word about the official symbol. That word is “lame”. It’s a lame symbol because it’s derivative of the human medical symbol, making veterinarians look like a junior league version. If anyone is going to use a symbol with snakes, it should be us, and they should have to superimpose an H on it. We actually handle snakes, whereas most modern physicians run screaming from them. The symbol originated from an ancient Greek healing cult involving releasing snakes among the patients. Presumably, this frightened the patients into at least claiming that they were feeling better so that they could leave. As that’s no longer the standard of practice, I feel the physicians should get their own symbol now and then we can keep the plain rod and snake without the tacked-on V. Failing that, we could politely ask the veterinary surgical specialists to allow us to use their centaur logo for the whole profession. Centaurs are cool.

End of digression. On to the coneheads. Officially known as Elizabethan collars, or e-collars for short, these lampshade shaped items are as indispensable to the veterinarian as the stethoscope, the syringe, and the scalpel. It’s one of the things that distinguishes us from our human medical counterparts, although I’m told that a local vasectomy surgeon keeps a large e-collar in his office as a joke. What a card. Humans can be told not to lick their wounds and incisions and, generally speaking, they won’t. Dogs and cats on the other hand… Well, the point is obvious.

So why do they lick? And is it even a problem?

Second question first. I have had quite a few people declare that it is natural to lick a wound. Yes, it is. But it is also natural to poop indoors. And it is natural to die soon after our reproductive years. Natural behaviours work best in natural environments and when there are no better alternatives.

Dogs and cats lick for two main reasons. The first is to clean the area. If it’s an accidental wound, initially this can be helpful. By all means, get those bits of bark out the cut from that sharp branch you ran into. The problem is that they don’t know when to stop. In the wild, a wound would keep getting dirty, so it made sense to keep cleaning it, but our pets eventually come into a (hopefully) clean home. At that point they’re just introducing bacteria from their mouths. A version of the licking-is-natural myth holds that their oral bacterial is beneficial. People who say this have never looked inside the mouth of a middle-aged dog with dental disease (which is to say, most middle-aged dogs). It’s like peering through the fetid gates of bacterial Hades. There’s a reason why you are always prescribed antibiotics after a dog or cat bites you. I remember a colleague who didn’t bother, and her hand turned black. True story. But I’m veering into digression again.

The other problem with the licking instinct is that they cannot differentiate between a dirty accidental wound and a clean surgical incision. I imagine dogs and cats waking up after an operation and thinking, “What the heck? Those people were all so friendly and nice and petting me and saying how good I was, but then, bam, I had an instant nap and now I wake up and there’s this cut on my belly! Did they drop something sharp on me? Didn’t they even notice!? Losers. And it’s got these bits of string stuck to it. Groan. Oh well, I know what to do. It’s just like those bits of bark that were in that cut from the Evil Stick…”

The second reason that dogs and cats lick is for comfort. It likely, albeit subconsciously, reminds them of when they were small and their mothers licked them. It’s soothing to them the way thumb-sucking or hair-twiddling is for some people. This self-soothing can become addictive and tip into obsessive-compulsive behaviour. Anxious cats will lick their bellies until they’re bald, and anxious dogs will lick their paws until they turn rust coloured (by the way, that colour is due to a substance called porphyrin in the saliva reacting with the air). A note of caution – sometimes these behaviours are also due to itchiness from allergies, so don’t assume your pet is developing an OCD and just slap the cone of shame on him. That would be agonizing if there’s a legitimate itch. And there are excellent medicines these days for allergies. Even for true excessive self-soothing and anxiety, a cone is not the best solution. The necessary behavioural therapy for these guys is well beyond the scope of this story (now, that would be a digression!), so ask your veterinarian for advice on this please.

But for the wounds and incisions, the cones are still the way to go. Theoretically bad tasting sprays and ointments are possible alternatives, but many pets laugh at these. You’ve seen what they’re willing to eat, right? Fortunately, however, the cones have come a long way. When I first started in practice, we only had the rigid opaque plastic ones. Dogs crashed into things and cleared coffee tables with them, and cats got stuck under couches and in cat doors. The modern ones are clear, to improve peripheral vision, and a little more flexible. They’re still a nuisance though. Even better for some pets are the floppy cloth ones (true “Elizabethan” collars that Shakespeare wouldn’t be ashamed to be associated with) and inflatable doughnut-style ones. I say “for some pets” because these are more easily defeated by the agile, the determined, the Houdini-like. You may have to try a few different options and sizes and means of attachment before you hit on one that is a reasonable compromise between nuisance and effectiveness.

Maybe the best veterinary symbol would be to put an e-collar on the centaur. You could also put one on the Asclepius snake, but that would just be dumb as snakes can easily reach around any collar. But a centaur with a cone wouldn’t be dumb. Not at all. Right?