The Dog-Related Injury

 
 

Pinta the Rottweiler and I were on our evening walk when she stopped suddenly, stiffening at the sight of another dog ahead on the sidewalk. I had time for two thoughts —Look out! and Nah, it’ll be okay— before 70 pounds of lunging muscle jerked the leash from 0 to 60, yanking my ring finger sideways. Oh damn, I thought when I caught my breath and looked down at its weird new angle. This is not good.

That turned out to be an understatement. Who knew that a joint could splinter? Two years, one complex surgical procedure, two casts and many months of physical therapy later, the finger (on my dominant hand, naturally) flexes just enough that I can type; I will never make a fist again. I would feel even stupider—I’ve owned big, strong dogs for 17 years, and knew better than to wrap the leash around my fingers as I did—if stories of others felled by their dogs hadn’t started coming my way. There was the emailed photo of a friend’s bloody face after her huge Akita mix tangled her in the leash and she went down. Another showed me a finger even more crooked than my own. I read about the French pro soccer player who missed a big game because he’d twisted his ankle while walking his dog, and the South African cricket goalie sidelined with a wrenched knee after an altercation featuring two Jack Russells.

What I’ve dubbed the “DRI,” or Dog-Related Injury, seems to be everywhere. We who love our dogs like to brag about how they keep us social, active and fit. What we don’t like to admit is that while those dogs (usually) don’t bite the hands that feed them, they have been known to break them.

How often do our sweet co-pilots trip us, knock us over, dislocate our shoulders and break our wrists, slam us in the knees, and head-butt us? Interestingly, no public agency seems to think it’s worth tracking the prevalence of DRIs, but orthopedists, ER docs, researchers and even professional dog trainers know the answer: a lot. In 2009, the Centers for Disease Control released an analysis of five years of emergency room injury data. In their report, some 86,000 fall injuries were associated with pets, mostly dogs, annually. (The injuries affected all age groups, but older patients were more likely to break a bone.)

Another study, done in 2010 in England, looked at traumaand fracture-clinic patients in a rural general hospital and found that a significant percentage of the injuries had involved the patients’ dogs. A majority had fallen, but two caught their fingers in their dog’s collar, one fell into a hole the dog had dug in the garden, and one had been pushing her reluctant dog out of the house into the rain when the dog suddenly moved and she tumbled down the front steps.

In 2005, in a letter to the New England Journal of Medicine, a Philadelphia physician with persistent elbow pain reported “discovering” a new condition, “Hogan’s elbow.” He traced his problem to walking Hogan, his unruly black Lab. Mark S. Cohen, MD, a hand and elbow surgeon at Rush University Medical Center and Midwest Orthopedics at Rush in Chicago, notes that he and his colleagues see DRIs that include severe finger and wrist fractures, dislocations, and ruptured tendons “all the time.”

DRIs can also be caused by less predictable events. In 2011, tabloids reported that Martha Stewart needed nine stitches to repair her upper lip after she leaned down to whisper goodbye to her sleeping French Bulldog, who bolted awake and knocked her in the face. Betty Pinkartz Donnelson was done in by a 12-pound Terrier, who came flying across the room when he spotted her on the couch putting on her shoes and thought that meant a walk was in the offing. “His head hit the base of my little finger at just the right angle, and I heard this loud pop,” she says. “I ran some errands and it kept swelling and hurting more. I had a spiral fracture and ended up with a metal plate, six screws and months of physical therapy. Two years later, I still can’t carry a suitcase in that hand.”

Photo by Harlie Raethel on Unsplash

Most of the time, though, a DRI is evidence of human error. “People get hurt walking a dog who’s never been trained, and whom they’re not capable of handling,” says Michael Chill of Los Angeles–based Animal Services Dog Training and Behavior. “They come to me after they develop carpal tunnel syndrome from yanking too hard on the leash for years.”

We also get hurt because we get lazy, careless, fail (like me) to pay attention to our dog’s signals or are so obsessed with our phones that we text even when that means holding onto 50 pounds of raw energy with one hand. We ignore advice about the dangers of retractable leashes, when a casual Google search reveals pictures of nightmarish leash burns and even tales of amputation. (One woman whose leash cord got pulled tight when her large Lab bolted was horrified to spot part of a human finger lying nearby, and even more horrified when she realized it was her own.)

In the mindlessness of the moment, we forget basic rules like never intrude on squabbling dogs. Dan Mayfield says his two Salukis “love to box, standing up on their rear legs, snarling and pushing each other around with their front paws. So one day they’re doing this, and I think it’s getting to be too much for the 10-year-old and stick my hand in to stop them, and the three-year-old bites me, hard, right through the web of my thumb.”

And sometimes, because we get lulled by the dull, sweet zen of daily walks on the same streets at the same time, we mistake an animal who craves predictability for one who is always predictable.

“One of my clients was walking her two dogs when both suddenly lunged after a squirrel that had come down from a tree,” says trainer Michael Chill. “Each dog ran to a different side and my client, caught in the middle, hit the tree and broke her nose.”

Sharon Jensen, who ran regularly with her Golden Retriever, Clancy—“always on a leash and always on my left, because I’m a good pet owner”—did fine until the day the two were sprinting and Clancy abruptly decided to swerve right. “He cut in front of me and I went head over heels over him,” recalls Jensen. “I got tangled in the leash, fell on my right side, badly sprained my ankle, scraped my knees, wrecked my wrist. This was in the days before iPhones, so I limped all the way home.”

Michelle Bekey’s beloved Great Dane mix, Ava, was 80 pounds and nine months old when, she says, “with no warning, he decided to dive at something behind me and yanked my arm and shoulder backwards. It felt like someone had put a cattle prod at the base of my neck. I found out later I’d torn two disks.”

Carole Pearson runs the rescue Dawg Squad and is no fool about big dogs, many of whom she’s owned and fostered over the years, but even she was a victim of her expectations. “When I had Jack, my original Rottie, who weighed 130 pounds, and Gus, an 80-pound Chow, I took them over to my mother’s house every day when I went to work, and fell into a routine of opening the car door and getting their leashes while they were getting out,” she says. “It was fine. Until one morning, they saw a cat. My mom lived at the top of a hill and they went downhill after it. I was wearing a long black dress, black boots and nylons, and when I took off after them, my mom said I looked like the flying nun. Half a block away, I fell, wrecked my clothes, gashed my knees and an elbow, and bruised a rib. There was a school across the street and some teachers ran out to help me—at which point, Jack, who thought they were hurting me, came back and stood over me, growling. I was screaming ‘Everybody get away if you don’t want to get bit!’ My mother laughed about it the rest of her life.”

Another common human mistake: forgetting that a new animal will probably act differently than a familiar one. Cathy Scott had trained her two dogs to sit and wait at the front door when it was time to go out. No one passed that message to June, a Lab/Pit mix someone dumped in Scott’s yard, and whom she’d agreed to foster. “I was getting ready to take all three dogs to the park, and had June’s leash wrapped in my fingers because I wasn’t expecting movement,” she recalls. “My dogs stayed still when the door opened, but June leaped, and I could hear my forefinger snap.” She adds, “I was going to the park to meet friends who wanted to network June, so we still went. When we got home, I iced my broken finger and finally went to the doctor.”

Another woman, too embarrassed to be identified, recalls taking a new, young Chow/Golden mix rescue for a walk at 10 at night. “Not the smartest thing I ever did. He saw something and went after it, and I went flying, dislocated my thumb and fell on my face so hard I lost a front tooth and broke my jaw. I was bleeding and my husband insisted we go to the ER, where they questioned the two of us separately about what had happened. I realized they thought my husband had hit me. After 20 minutes, they finally accepted that it had been the dog.”

The sad irony of a DRI is that the damage often outlasts the beloved animal who caused it. Clancy, the Golden who sent Sharon Jensen sprawling, passed away years ago, but that fall was the beginning of a long orthopedic journey, she says. “I would’ve had problems with my hips eventually, but the accident messed them up earlier. It really had lifetime consequences. Clancy will have my heart forever—and his behavior has my bones.”

 

The Veterinarian Brings His Healing Presence to Pets of the Unhoused

 

 

The man standing outside the tent on Skid Row in downtown Los Angeles clearly doesn’t live in the neighborhood. Tall and fit, he’s dressed in jeans and a doctor’s blue scrub shirt and carries a medical bag. The tent, one of many rough structures on the stained sidewalk, sits amid heaped wooden pallets, old furniture and trash. But the man’s eyes are fixed on the dog lounging nearby.

“Hi, how are you?” he says when the tent flap opens. “I’m a veterinarian, Dr. Kwane Stewart, and I offer free pet care to people experiencing homelessness.” He gestures at the dog. “Can I examine your pet?” 

First comes confused silence—you’re who?—then suspicion: Is this animal control, here to take my dog? Finally, a slow nod. Stewart, who calls himself the Street Vet, kneels, pulls out his stethoscope and goes to work.

These Skid Row streets hold the nation’s largest concentration of homeless people who are not staying in a shelter, and at first glance it’s an unrelieved landscape of despair: mental illness, poverty, addiction. But love exists, too, including the love of pets. Across the nation, 10 to 25 percent of the people who are homeless keep pets, and there’s no reason to think the number is lower in sunny Los Angeles. Cats sit on sleeping bags, pit bulls, scruffy terriers and mutts trot alongside filled shopping carts, and chihuahuas ride in bicycle baskets and the laps of people who themselves are in wheelchairs. Various local groups and volunteers help the owners of these animals care for them, with weekly and monthly clinics, mobile spay and neuter vans, handouts of flea meds and food. 

Stewart, 50, has usually worked solo, walking the streets and looking for animals and people in need. “Maybe it’s because when I began this work, it wasn’t uncommon to find a pet that had never received care,” he says. “Everyone I met looked at me as if I’d just dropped out of the sky.”

Stewart grew up with dogs, loved them and science, and by the time he was 10 knew he would become a veterinarian. It was an unusual ambition for a Black track star in Albuquerque. Once, a coach asked about his future plans and laughed with disbelief when Kwane told him. “I’ve never met a Black vet,” the coach said. Stewart goes on, “At the time I didn’t think much about it. But here’s the thing: He was Black himself.” Decades later the number of African American veterinarians is still so small the Bureau of Labor Statistics has reported that it might as well be zero. 

Stewart graduated from the University of New Mexico, got his DVM degree from Colorado State University College of Veterinary Medicine and Biomedical Sciences, and headed to San Diego. He spent a decade there treating a suburban clientele with “bottomless bank accounts.” Then, in 2008, he relocated to Modesto, in California’s Central Valley, for a job as the veterinarian for Stanislaus County. And everything changed. 

The Great Recession flattened Modesto, a city of around 200,000, with plummeting home prices and 17 percent unemployment. And when humans go broke, animals often pay the price. Pet surrenders surged until the area’s aging shelter, built for 200 animals, held twice as many, and its euthanasia rate became one of the nation’s highest.

“I was destroying 30 to 50 animals every morning,” Stewart says softly. “Healthy dogs and cats. It was killing my soul. I felt like God was keeping score and I was losing. I didn’t go to school all those years to destroy animals. I wanted to help and save them.”

At first that meant he helped a homeless man he encountered almost daily by treating the man’s dog, which suffered from a bad flea bite allergy. Then he held a free clinic at a local soup kitchen. And then, on his own time, he began to walk around Modesto and some Bay Area sites looking for pets to help. He moved to Los Angeles to serve as chief veterinary officer for the American Humane Association, which makes sure animals are treated well on film sets, and his ramblings shifted to San Diego and Los Angeles. He wore scrubs to identify himself, carried a bag filled with meds, vaccines and syringes, nail trimmers, and he did what he could, free of charge. 

He was stunned by what he found. Like many people, he questioned why homeless people had animals to begin with—if humans couldn’t take care of themselves, how could they be responsible for pets? And yet they were. In fact, numerous academic studies over the years have revealed the vital role pets play in the lives of unhoused men and women—providing structure, purpose, meaning and love. “Researchers have consistently found very high levels of attachments to pets among the homeless,” Leslie Irvine, a sociologist, writes in her 2012 book about the phenomenon, My Dog Always Eats First.

Stewart agrees. “Pets were a lifeline to the people I met,” he says. “Most of them were great pet owners. They did remarkably well with the resources they had, and made sacrifices for them well beyond what you or I would. The bond between them was on a completely different level. They needed each other.”

 

For five years, his efforts were a kind of secret hobby that he says even his family—he has three children—didn’t know about. Then, in 2017, he and his brother, Ian, produced “The Street Vet” as a reality TV series­—it has aired on broadcast TV in Scandinavia and Eastern Europe and in the States on a Utah cable channel­—and Stewart acknowledges he’s now a “media personality.” These days he’s founding a new veterinary practice in San Diego and writing a book about his experiences on the street.

Last September he started a nonprofit, Project StreetVet, raising money on GoFundMe to cover the cost of treating pet medical problems beyond the scope of a sidewalk exam. He has occasionally volunteered with larger organizations assisting people who are homeless. Though he says “there are probably more efficient ways I could spend my time,” he likes doing it his way. 

“The wound is healing well,” he reassures a man named Ben, whose pet rat had been attacked by a cat. (“I’ve seen birds and snakes, but this was my first rat.”)

“The puppies look great,” he tells Julian, a tattooed man who has lived on the same stretch of pavement for two years and whose dog recently gave birth. (He also vaccinates the pups.) 

Stewart marvels at the generosity of a young man named Reggie, who lives in a school bus and uses his own cash to make lemonade that he gives away to his neighbors. Stewart vaccinates the man’s dog, Daisy. “You’re doing a good job,” Stewart says.

“Oh, this is such a blessing,” the young man replies. 

Most Americans Have Pets. Almost One Third Can’t Afford Their Vet Care

Since mid-2020, more than a thousand low-income families have brought their sick and suffering pets to the nonprofit Pet Support Space, housed in a tiny Los Angeles storefront. One 14-year-old dog had a tumor that a veterinarian had quoted $5,000 to remove. A four-year-old pit bull had been vomiting for days, a cat’s painful bladder stones required surgery, a pug limped from the foxtail embedded in its paw. Skin and ear infections abounded. Neither the animals’ problems nor their owners’ inability to afford help for them was a surprise.

recent nationwide study found almost 28 percent of households with pets experienced barriers to veterinary care, with finances being the most common reason. In low-income households, the researchers found, financial and housing insecurity can increase the risks that animals will not receive the care they need. Sociologist Arnold Arluke, author of Underdogs: Pets, People and Poverty estimates that 66 percent of pets in poverty have never seen a vet at all.

The “why” behind those numbers is complex. Of course, money is the primary problem. Veterinary care is expensive. A majority of practitioners work in for-profit clinics, consolidation in the industry has increased emphasis on profit margins, and vet prices have risen faster than the overall rate of inflation. That has checkups starting at $50, dental cleaning going for $70-$400, and blood work and x-rays at $80-$250. If a dog breaks a leg or eats a sock, surgery costs begin at four figures.

High prices aren’t necessarily about greed. Michael Blackwell, a former Deputy Director of the Center for Veterinary Medicine at the FDA, is the chair of the Access to Veterinary Care Coalition (AVCC) that was formed in 2016 to study this very problem. Veterinary training, he said, teaches vets to practice a “gold standard” of care, which means running every possible diagnostic test and pursuing every treatment option, even when a client’s budget is limited. (Many pet owners don’t know they can decline a recommended procedure, such as blood work, and even fewer are willing to decline care for fear of looking heartless.)

Some private vets offer struggling clients discounts, added Jeremy Prupas, DVM, Chief Veterinarian for the City of Los Angeles, but they themselves carry an average of $150,000 in student loan debt, so they simply “can’t carry the immense existing need on their own.” Telling clients you can’t help them because they have no money is one of the leading causes of burnout in the veterinary profession, according to Prupas. Pet insurance might help defray costs but requires monthly premiums and comes with such a complicated array of deductibles, co-pays, caps, and exclusions that one how-to guide recommends hiring an attorney to review the policy. Credit cards designed for medical care financing, if one can qualify, can carry punishing interest rates as high as 26.99 percent.

Equally critical is a long-term failure on the part of the animal welfare movement to consider, much less prioritize, the needs of low-income pet owners. Since the 1990s, the rescue/humane world has poured vast amounts of funding and energy into cutting shelter euthanasia through adoption, but far less into helping those without money take care of the pets they have. “If you can’t afford an animal,” the thinking went, “then you shouldn’t have one.”

“Until recently, we focused on shelter-centric challenges,” acknowledged Amanda Arrington, senior director of the Humane Society of the United States’s Pets for Life Program, which assists low-income pet owners. “There was a lot of judgment and making determinations on who was or wasn’t deserving of support and resources that was influenced by what I think a lot of society is influenced by, which is classism and racism. We conflated a lack of financial means and access with how much someone loves their pet or desires to care for it.”

In fact, owners can be punished because they can’t afford veterinary care — “most humane neglect cases stem from an inability to get care for a pet,” said Prupas. In Michigan, for example, failing to provide an animal with adequate care, including medical attention, is a misdemeanor that can carry 93 days in jail and/or a fine of up to $1,000. With a second violation, it becomes a felony.

The distorted belief that ‘those people’ don’t care about their pets has never been true.

What exists for pet owners in poverty is a patchwork of low-cost care options, ranging from local efforts — such as Emancipet in Texas and the Philadelphia Animal Welfare Society — to well-funded national enterprises such as Pets for Life, which operates in several dozen cities. The great majority, however, offer only basic services like sterilization, vaccination, and flea treatments. “We are not a full-service veterinary clinic and do not treat sick or injured pets,” warns one low-cost option on its website. Another suggests that needy people travel, since “vets in smaller towns may charge lower fees,” or start a GoFundMe. As a result, many types of care are largely unavailable: emergency care (by some estimates one in three pets will have an emergency need each year), management of chronic conditions such as diabetes or kidney disease, medication, dental care (dental disease affects perhaps 80 percent of older dogs), and the mercy of humane euthanasia (which can run $50-$300).

The final piece of the care gap is a practical and cultural disconnect. Because many economically challenged neighborhoods are “vet deserts,” with few if any practitioners, it’s not easy to find care, and reaching it can require wrangling an unhappy animal over distance and/or arranging private transportation. Keeping an appointment at an office with weekday-only business hours or a once a month clinic can mean losing a day’s pay. Paperwork raises the fear of immigration status inquiries. The veterinary profession also remains one of the country’s whitest: Just as people who feel alienated or unwelcome don’t utilize human health care options, pointed out Arluke, they don’t utilize care for their pets.

The result has been suffering: most directly for animals that remain untreated, die from what vets call “economic euthanasia” (putting an animal down because treatment costs too much), or end up in shelters. Fear of a looming vet bill, and the mistaken belief that all shelter animals receive medical care, is a prime cause of owner surrender.

But people pay, too.

Some sick animals can infect their humans. Roundworms, for example, can pass through contact with pet feces and cause lung, heart, and eye problems. Blackwell reports meeting an optometrist who practices in a low-income Florida community who has seen increasing numbers of children with roundworm larvae in their eyes.

The psychic toll is just as real. Families in poverty who love their pets and for whom “they offer an emotional core and possibly one of the only sources of joy” face “mental and emotional” devastation from the unimaginable choice of weighing that love against potential financial ruin, said Blackwell. Professor Katja M. Guenther, author of The Lives and Deaths of Shelter Animals, called the rupture of an animal-human bond “a kind of community violence” in a 2021 webinar.

Change seems increasingly possible. Covid-19 and the country’s recent racial and economic reckoning has prompted humane organizations to examine their assumptions and biases about who has the “right” to a pet’s love, and, said Arrington, there’s increasing recognition that “racial and economic injustice really impacts animal welfare.” Meanwhile, AlignCare, a new program out of Michael Blackwell’s Program for Pet Health Equity, is trying to create a national model of something like Medicaid for domestic animals. Under the program, families already found to be struggling (because they participate in SNAP or a similar program) and who ask for help at a shelter or veterinary clinic will be signed up and paired with a veterinary social worker or support coordinator. They’ll then be directed to a veterinarian who has agreed to offer preventative, dental, and even critical care, for a reduced fee; AlignCare will pay 80 percent of the cost. After three years of pilot programs in 10 disparate communities, it’s taking on its biggest challenge yet, Los Angeles, where one in five people live in poverty.

AlignCare won’t offer “gold standard” care, instead emphasizing preventative, incremental, and cost-saving measures (such as offering telehealth appointments and limiting diagnostics that won’t change treatment options) when possible. But it will expand the human safety net to include the animals most of us now consider part of our families. And while the effort is currently funded by grants from Maddie’s Fund, the Duffield Foundation, and Petsmart Charities, Blackwell’s goal is “community ownership:” The combined involvement of local vets, city animal services departments, social service agencies, rescue and community organizations, pet food and product manufacturers, and affluent pet owner-donors can make the model self-sustaining.

There is no perfect solution for low-income pet owners who need help accessing veterinary care. But growing awareness of the problem is a big step forward. “What we call ‘animal welfare’ is changing,” said Lori Weise, whose nonprofit, Downtown Dog Rescue, runs the Pet Support Space. “The distorted belief that ‘those people’ don’t care about their pets has never been true. People can’t afford care. Sometimes they don’t even know what’s out there; they themselves have never been in a hospital. As more people are brought into the system, we’ll see the first generation to get proper veterinary care.”

 

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