Preventing Pressure Sores in Disabled Pets
Pressure sores (sometimes called Bed Sores) are areas of injured skin and tissue. They are usually caused by lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn't occur often enough and the blood supply gets too low, a sore may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers.
Pressure sores can be serious, depending on how much the skin and tissues have been damaged. If the sore becomes an open wound, you'll want to get antibiotics from the veterinarian and also put antibiotic ointment into it at least a couple of times a day to keep it from getting infected..
Mild damage causes the skin to be discolored, but a sore doesn't form. In light-skinned dogs, the damaged skin may turn dark purple or red - you may not see it until the fur gets matted and falls out. . In dark-skinned dogs, the area may become darker than normal. The area of damaged skin may also feel warmer than the surrounding skin.
Deep sores can go down into the muscle, or even to the bone. If pressure sores are not treated properly, they can become infected. An infection in a pressure sore can be serious. Pressure sores also hurt a lot and make the dog reluctant to move at all.
A dog that is not able to move on his own will get pressure sores if not moved often (at least 2-4 hours) depending on how soft an area he is lying on. Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for pressure sores to heal because of a poor blood supply to the area so if your dog has other health problems, watch the area around the hips, elbows and knees closely for discoloration.
Pressure sores can develop over bony areas that don't have much padding. Pressure sores are most common on the hips and elbows in dogs. They start out looking red and irritated, but without sufficient padding, or movement (turning every 2 hours) they can become gaping holes.
Treatment of Bed Sores in Dogs
- Relieving the pressure that caused the sore
- Treating the sore itself
- Improving nutrition and other conditions to help the sore heal
Don't allow the dog to lie on pressure sores. Use foam pads or pillows to take pressure off the sore. A donut works especially well for the dog's hips and children's "water wings" may be helpful for elbow sores. Avoid allowing the dog to rest directly on the hip bone and switch sides often. A bumpy foam pad on top of his regular pad is helpful.
In order to heal, pressure sores must be kept clean and free of dead tissue. You can clean the sore by rinsing the area with a salt-water solution. The salt water removes extra fluid and loose material. 
Pressure sores should be kept covered with a bandage or dressing which isn't easy because dogs have fur and there is nothing that wants to stick it to. You also want to keep the dog from licking the sore. What I've found works is to put a clean dressing on the sore, then cover the dog with a blanket. If necessary use an E-collar, but if you can avoid that I would - the dog is probably uncomfortable enough already. . Newer kinds of dressings include a see-through film and a hydrocolloid dressing - but they would probably only work well on a shaved or short haired dog. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore. These dressings can stay on for several days at a time in a perfect world. I used some and had to change it at least once a day because being a dog they have fur and you can't tape a bandage on good enough to stay that long. That made the cost insanely expensive.
Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore every time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. If it's hanging out like a hunk of dead skin, you can actually just cut it off with sterilized scissors. (I expected a yelp, she did nothing so maybe it felt better?).
Removing dead tissue and cleaning the sore can hurt. Make sure you give your dog a pain reliever before changing the dressing. Our vet prescribed Tramadol, but your vet may prefer to use something else. Hoover also seemed to do well on Rimadyl. For Jazzy I have used CBD oil for pain. It has fewer liver and kidney issues, and fewer conflicts with other potential drugs your dog may be taking.
Good nutrition is important because it helps his body heal the sore. If your dog doesn't get enough calories and a high quality food with protein and other nutrients, his body won't be able to heal, no matter how well you care take care of the bed sore. Even though the dog is not mobile, he may need just as many calories as before to fight infection and maintain a fatty layer. There's a fine line between being too heavy (and causing other problems) and having enough fat. You may want to get another opinion from your vet as most owners have a hard time telling if a dog is obese or too thin.
Infection and Pressure Sores
Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of the body. If you notice any of the signs of infection listed below, call your doctor right away.
- Thick yellow or green pus
- A bad smell from the sore
- Redness or warmth around the sore
- Swelling around the sore
- Tenderness near the sore
- Fever or chills
- Mental confusion or difficulty concentrating
- Rapid heartbeat
- Weaknes
The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, intravenous antibiotics (given through a needle put in a vein) are often required. Oral antibiotics are often given as a preventative. These are both examples of pressure sores that are not infected. If infected they will be much redder and some swelling will be visible. 
As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the edges of the sore. It may take 2 to 4 weeks of treatment before you see these signs of healing. The most important step to prevent pressure sores is to avoid prolonged pressure on one part of the body, especially the pressure points mentioned previously. With dogs, the most dangerous place to watch for is the hips. As they lose muscle, there is less padding to protect the boney areas. If the dog is bedridden a long time eventually the dark red area will become an actual "hole" - right down to muscle or bone. It's almost impossible to avoid this without 24/7 constant care after a long period of time. (why hospitals have nursing STAFF)...So don't beat yourself up if your bedridden dog develops this. The main thing is to keep it healing and stop infection before it can spread. If it's on the hips you'll likely have one side improve, and the other side get worse, then they'll switch.
We've used an inexpensive antibacterial home made salve that has worked very well. Much cheaper and works better than any store-bought concoction you can buy. It's also important to take pressure off the area with foam padding and constant turning.
The pressure sore concoction:
1/2 cup organic coconut oil
1/2 cup local raw honey,
1 Tablespoon Comfrey (powder)
1 Tablespoon Tumeric (powder)
1/2 cup pure Aloe Vera juice
3 drops tea tree oil
optional: 1/2 dropper CBD oil
Mix together and make a gloopy cream. (it will tend to separate, mix as best you can)
You may have to warm the coconut oil so it will mix with the other ingredients, make sure it's cool before putting on the wound.
Put this on a soft pad or directly on the pressure sore. Mother's breast feeding nursing pads work really well, are inexpensive and they are absorbent, round and conical, but soft. Use masking tape to stick it to the skin or fur (you can use other products, but you'll use a LOT and masking tape is cheaper and sticks to fur better than most medical tapes).. Infection is the enemy, so change the dressing often - dogs that can't move will pee on themselves making the problem worse. So put down a pee-absorbent pad and roll an old towel up and put between the legs and either over the vulva or penis to absorb the majority of the urine. This will keep your dog drier and especially on longer coated dogs, they'll absorb less urine into the fur.
Any sign of serious infection, give antibiotics....Clavamox works well.
