Noncombat-related injuries or illnesses incurred by military working dogs in a combat zone

Matt S. Takara Public Health Command Region-West, Camp Pendleton Veterinary Service, Building 20846 Box 555230, Marine Corps Base Camp Pendleton, CA 90255.

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Karyn Harrell Randall B. Terry Jr. Companion Animal Veterinary Medical Center, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695.

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Abstract

Objective—To determine the most common types of noncombat-related injuries or illnesses in military working dogs in a combat zone.

Design—Retrospective descriptive study.

Sample—1,350 patient encounters with military working dogs evaluated for noncombat-related reasons.

Procedures—Data regarding noncombat-related veterinary visits were collected on a weekly basis from 13 forward operating bases throughout Iraq from January 2009 through August 2010. Reporting facility location, patient identification, reason for evaluation, diagnosis, and treatment were recorded, and descriptive data were summarized.

Results—The most common noncombat-related disease processes or injuries identified were related to the dermatologic system (ie, primary [inflammatory] dermatologic disease; 338/1,350 [25.0%]), soft tissue trauma (284 [21.0%]), alimentary system (231 [17.1%]), or musculoskeletal system (193 [14.3%]).

Conclusions and Clinical Relevance—Veterinary Corps officers need to be proficient not only in the management of combat-related injuries but also in the treatment of routine illnesses and injuries. Knowledge of noncombat-related diseases and injuries commonly incurred by military working dogs can be used for targeted training for individuals responsible for medical care of these animals as well as for equipment selection and protocol development.

Abstract

Objective—To determine the most common types of noncombat-related injuries or illnesses in military working dogs in a combat zone.

Design—Retrospective descriptive study.

Sample—1,350 patient encounters with military working dogs evaluated for noncombat-related reasons.

Procedures—Data regarding noncombat-related veterinary visits were collected on a weekly basis from 13 forward operating bases throughout Iraq from January 2009 through August 2010. Reporting facility location, patient identification, reason for evaluation, diagnosis, and treatment were recorded, and descriptive data were summarized.

Results—The most common noncombat-related disease processes or injuries identified were related to the dermatologic system (ie, primary [inflammatory] dermatologic disease; 338/1,350 [25.0%]), soft tissue trauma (284 [21.0%]), alimentary system (231 [17.1%]), or musculoskeletal system (193 [14.3%]).

Conclusions and Clinical Relevance—Veterinary Corps officers need to be proficient not only in the management of combat-related injuries but also in the treatment of routine illnesses and injuries. Knowledge of noncombat-related diseases and injuries commonly incurred by military working dogs can be used for targeted training for individuals responsible for medical care of these animals as well as for equipment selection and protocol development.

Military working dogs have been an important component of the US military's assets since World War II1,2 and have been involved in combat in many major US military engagements. These dogs perform functions ranging from detection of explosives and narcotics to general patrol work and scent tracking. As threats engaged by military forces have changed, the training and use of MWDs have evolved to meet the challenge. Several reports3–7 have described combat-related injuries to MWDs, but to our knowledge, no information has been published describing noncombat-related injuries and illnesses affecting MWDs living and working in a combat zone.

Most VCOs who deploy in direct support of MWDs are recent graduates (ie, veterinarians with < 3 years of clinical experience) or US Army Reserve veterinarians who take a leave of absence from their regular jobs.8–10 All Army veterinary personnel undergo predeployment training, not only to prepare for battle conditions, but also to ensure veterinary medical proficiency. Information regarding what to expect and how to prepare for the veterinary medical mission of the deployment is received through direct briefings from personnel in outgoing units and from after-action reports. However, lessons learned from previous deployments are not always compiled to a central database and the data are not used by all personnel. At the military detachment level, the primary method of data collection involves workload spreadsheets that are difficult to mine for useful trends even when viewed retrospectively. Information is also affected by routine turnover of multiple veterinarians assigned at the various levels of command, leading to discontinuity and loss of data. The purpose of the study reported here was to retrospectively determine the types of noncombat-related injuries and illnesses typically incurred by MWDs in an active combat zone, with the goal of better informing disease and injury treatment and prevention planning.

Materials and Methods

Data were collected from veterinarians serving in a Medical Detachment Veterinary Services unit in Iraq from the week beginning January 5, 2009, through the week of August 23, 2010. Data were collected at 13 clinics that were located in different geographic locations throughout Iraq on the basis of MWD kennel locations as well as food safety and defense missions. Veterinary personnel at each individual duty site reported information to their headquarters on a weekly basis. Data were screened and entered into an electronic master database then forwarded to the task force or brigade headquarters and the US Army Central Command surgeon's office. Information obtained prior to January 2009 did not contain sufficient data for study inclusion.

Every patient encounter by VCOs was recorded. Information obtained included the calendar week in which the injury or illness occurred, reporting facility location, patient name and tattoo information (if available), type of visit (noncombat injury or illness, combat-related injury, physical examination or health certificate, or recheck examination), chief reason for evaluation, diagnosis, and treatment. On occasion, a definitive diagnosis was not readily available at the time that reports were due to be submitted, so the most likely differential diagnosis was included in the initial report. Age, breed, and sex were not routinely recorded. Follow-up reporting was also not routinely required owing to military work requirements and the fact that most reports required the use of limited secure networking time and resources. Follow-up examinations were made as deemed appropriate by the attending veterinarian and were only constrained by the overall military mission. Because patient medical records travel with individual MWDs and are not part of any centralized database until the end of the dog's service life (when records are forwarded to the Records Repository at the Department of Defense MWD Veterinary Service), review of each dog's medical record was not feasible.

The summary data for all MWDs seen at veterinary clinics in Iraq during the study period were screened to identify patient encounters that involved noncombat-related illness or injury. Data were excluded from the study for the following reasons: the dog was seen for purposes of physical examination and health certification with no abnormalities noted, the evaluation was recorded as a recheck examination for a preexisting condition, or the injury was considered combat related. Patient encounters were considered recheck examinations if indicated as such on the spreadsheet or if the patient was seen again within a 14-day period for the same reported clinical problem. If an evaluation occurred > 14 calendar days after the previous examination, it was considered a new patient encounter.

Noncombat-related injury and illness data were categorized primarily by the body system reported to be affected. Often, dogs had multiple clinical signs due to underlying disease processes. For the purpose of this report, the most predominant sign was chosen for categorization. Several deviations from the primary classification system were necessary to better capture the types of injuries or illnesses of MWDs or the reason for the visit. Traumatic injury affecting the dermal and subcutaneous tissues was categorized as soft tissue–related injury to differentiate the findings from inflammatory conditions of the skin that did not result from trauma (which were classified as dermatologic). For patients evaluated specifically because of a mass lesion (eg, lipoma), the condition was classified as a mass, whereas other neoplastic conditions were reported according to the primary body system affected (eg, hepatocellular carcinoma was reported as multisystemic). Surgeries were all for orchiectomy or ovariohysterectomy and were grouped separately from the urogenital system to differentiate from inflammatory and infectious disease processes. Toxicosis was distinguished from alimentary or neurologic disease because all of the cases involved known toxin ingestion and dogs were brought to the clinics specifically for treatment. An open diagnosis category was used to capture data for dogs that had nonspecific clinical signs with no presumptive or definitive diagnosis at the time of required reporting. Evaluations of apparently healthy dogs involved in vehicular accidents (with the patient inside a vehicle at impact) were categorized as other. Data were further grouped on the basis of clinical signs and working diagnosis. This information was assessed as the percentage of total veterinary patient encounters and of encounters in each assigned category. No additional statistical analyses were performed.

Results

Data from 5,894 veterinary patient encounters were initially screened. Of these, 4,544 were excluded from the study (3,584 visits were for physical examinations and health certifications, 948 were for recheck examinations, and 12 were for combat-related injuries). Data for the remaining 1,350 patient encounters for noncombat-related reasons were included in the analysis; these most commonly involved the dermatologic or alimentary system, soft tissue–related injuries, or the musculoskeletal system (Table 1).

Table 1—

Number and percentage of veterinary patient encounters in which MWDs were evaluated for noncombat-related reasons in combat zones of Iraq between January 5, 2009, and August 23, 2010.

CategoryNo. (%) of patient encounters
Dermatologic338 (25.0)
Soft tissue–related injury*284 (21.0)
Alimentary231 (17.1)
Musculoskeletal193 (14.3)
Mass lesion52 (3.9)
Ophthalmologic51 (3.8)
Urogenital47 (3.5)
Dental34 (2.5)
Surgical19 (1.4)
Neurologic18 (1.3)
Multisystemic17 (1.3)
Respiratory17 (1.3)
Open§16 (1.2)
Toxicosis-related12 (< 1)
Behavioral7 (< 1)
Cardiovascular6 (< 1)
Endocrine4 (< 1)
Other2 (< 1)
Infectious2 (< 1)
Total1,350

Most patient encounters were categorized on the basis of body system or tissue primarily affected; in some cases, classifications were modified to better capture the nature of injury or illness or the reason for the visit.

Included injuries of the dermis and subcutaneous tissues not attributed to primary (inflammatory) dermatologic disease.

The mass category comprised grossly detected mass lesions only; other neoplastic conditions were categorized by body system affected.

Included orchiectomy and ovariohysterectomy only.

Visits for nonspecific clinical signs for which no presumptive or definitive diagnosis was made.

Included known toxin ingestion.

Visits for evaluation of apparently healthy dogs involved in vehicular accidents (with the patient inside the vehicle when the accident occurred).

The 4 most common dermatologic causes for evaluation were otitis externa (117/338 [34.6%] patient encounters), generalized superficial pyoderma (36 [10.7%]), atopic dermatitis (31 [9.2%]), and acute moist dermatitis (27 [8.0%]). Otitis externa and generalized superficial pyoderma were attributable to yeast (48/117 and 3/36, respectively), bacterial (55 and 32, respectively), or mixed (14 and 1, respectively) infections. Atopic dermatitis was diagnosed in dogs with inflammatory skin conditions and no obvious signs of infection. Acute moist dermatitis was reported when there were localized lesions with no obvious signs of underlying disease (eg, external parasites). Other conditions associated with ≥ 1% of patient encounters included sebaceous cysts, scrotal dermatitis, pododermatitis, insect bite, hygroma, facial swelling, lick granuloma, alopecia, and immune-mediated disease. Less than 1% of these visits were because of seborrhea, matted fur, flea allergy dermatitis, skin tag, abscess, keratin horn, demodicosis, nasal hyperkeratosis, or vaccine reaction.

The 4 most commonly encountered alimentary system–related conditions were diarrhea (73/231 [31.6%] patient encounters), vomiting (47 [20.3%]), hematochezia (31 [13.4%]), and gastrointestinal foreign bodies (18 [7.8%]). Other conditions that were reported in ≥ 1% of visits were weight loss (attributed to inadequate caloric intake or increased metabolic output), anal gland impaction, gastric dilatation and volvulus, anorexia, constipation, gastrointestinal parasites, and hernias (umbilical or perineal). Less than 1% of visits were because of sialocele, signs of acute abdominal pain, tongue injury, or flatulence.

The 4 soft tissue–related injuries seen most commonly were foot pad or paw injuries (91/284 [32.0%] patient encounters), lacerations in locations other than foot pads or paws (46 [16.2%]), tail tip trauma (31 [10.9%]), and dog bite wounds (31 [10.9%]). Thirty (10.6%) of these injuries involved broken nails or signs of nail bed pain. Foot pad and paw injuries were most often attributed to working on hot, rough surfaces (71/91 [78.0%]). Other conditions accounting for ≥ 1% of patient encounters in this category included chronic wounds, puncture wounds, vehicular trauma (patient hit by a vehicle), blunt trauma, bite or other wound resulting from animal contact (other than dogs), draining tract (with no foreign object identified), and injury from a foreign body. Conditions reported in < 1% of visits were fasciitis and traumatic injury from a vehicle rollover or from jumping off a building and gunshot wound (incurred in a noncombat-related incident).

Musculoskeletal diseases were localized to hind limbs (91/193 [47.2%] patient encounters), forelimbs (52 [26.9%]), vertebral column and associated musculature (21 [10.9%] with 16/21 visits because of injury to the lumbar region), or tail (11 [5.7%]) or were not localized (18 [9.3%]). Generalized localizations were used for study purposes owing to a lack of specific joints noted in the initial reports. Radiology systems were not available in most clinics, and agreements with local human clinics were often made for radiographic evaluation of patients (this was not frequently completed within the same reporting period, preventing more specific anatomic localization in the present study).

Discussion

During the study period, MWDs were deployed or redeployed on 12-month rotations; throughout Operation Iraqi Freedom, rotations for MWDs in Iraq have had durations of 6 to 15 months depending on the branch of service and the type of MWD.11

The MWD procurement process is meant to reduce the frequency of genetic and developmental diseases common to large-breed dogs in these populations. All MWDs are screened for hip and elbow dysplasia via radiography. Each dog is required to pass a general physical examination, routine hematologic and biochemical screening, and testing for several infectious diseases. Military working dog handlers attend a training course that covers all aspects of handling an MWD, including basic canine first aid and emergency procedures, and they subsequently undergo refresher training. Other skills are attained through on-the-job training, quarterly sustainment training, and additional formal courses (eg, supervisors’ course, kennelmasters’ course, or advanced certification classes) during the handler's career.

All MWDs receive semiannual examinations by a VCO. One of these examinations includes evaluation of the results of serum biochemical analysis, CBC, and urinalysis. All MWDs receive preventive treatment against heartworm infection, flea and tick infestation, and sandfly bites. Long-term benefits of these treatments were not evaluated in the present study.

German Shepherd Dogs and Belgian Malinois are commonly used as MWDs because these breeds have traditionally undergone dual training (patrol and attack training and either explosives or drug detection training) for police and military work. The breed and sex of dogs procured as MWDs are typically based on availability at the time of purchase. Because data were lacking, breed, sex, and age of dogs were not investigated in the present study. The data from the present study confirm the need for VCOs, including those in deploying units, to be proficient in the diagnosis, treatment, and management of common noncombat-related conditions including dermatologic, alimentary, and musculoskeletal diseases and soft tissue trauma. In a recent study,12 gastrointestinal problems were found to be the most common reason for evaluation of police dogs in an emergency service, followed in frequency by orthopedic problems, traumatic injury and wounds, dermatologic disease, and neoplastic conditions. Data from the present study revealed that dermatologic problems were the most common reason for veterinary visits, most likely because the clinics in Iraq served not only as the dogs’ emergency facility but also as their primary care facility. The VCOs and animal-care specialists lived at or very near the veterinary clinic and were on call 24 hours a day, 7 days a week, throughout their deployment, and appointments were not required for treatment.

Familiarity with noncombat-related disease conditions typically encountered in a combat zone will help ensure preparedness and competent care for MWDs in such regions. This information can also be used in discussions with handlers during their training courses as well as in veterinary consultations for MWDs to increase awareness of disease processes, emphasize preventative care and husbandry, and potentially reduce the occurrence of common conditions or their severity before veterinary care is sought.

Although the kennel locations of dogs in the present study were in a desert environment, our subjective observation was that the kennel surfaces often remained moist or wet because of very frequent cleaning, disinfecting procedures, and the manner in which they were constructed. Kennel construction was highly variable among locations, and facilities ranged from portable 8 × 10-foot cages to brick and mortar buildings with poured-concrete foundations. The quality of the flooring was not consistent among locations and not of the quality seen or expected in the United States. The concrete had a substantial rock component and was brittle and very porous, allowing the floor to remain wet for extended periods of time. In the authors’ opinion, a resulting high level of moisture and humidity could potentially have contributed to the relatively large number of veterinary visits for otitis externa and dermatitis reported in this MWD population. Although otitis externa and superficial pyodermas are often considered processes secondary to allergies or endocrine disease, in the theater of operations, testing for allergies (eg, food trials and intradermal or serum tests) was not possible and reference laboratory testing was not available.

Diarrhea (including soft feces), vomiting, and hematochezia (with or without diarrhea) were the most commonly reported predominant clinical signs for dogs with alimentary system–related disease. Small bowel versus large bowel disease was not differentiated in reports. Most of these cases were attributed to kennel- and work-related stress. Potential stressors associated with the kennel environment include constant movement of personnel, other dogs in close proximity, and 24-hour operations. Although these specific factors were not investigated, work-related stress would be expected to vary according the dogs’ certifications and whether they performed as part of on-base operations (eg, vehicle inspections, clearing buildings and barracks, and force deterrent patrols) or so-called outside-the-wire missions (which may have included long patrols, searches of buildings and persons, and roadway clearing activities as well as potential encounters with hostile activity).

Most veterinary visits for dogs with soft tissue–related injury or illness (91/284 [32.0%]) involved injuries of the paws or foot pads. Injuries to soft tissues of the feet can substantially limit the working ability of these dogs. Injuries ranged from lacerations of the foot pads or paws to pad abrasions; these can result in severe lameness and prevent the canine team from performing its mission. Military working dogs may often need to maneuver over rough, uneven terrain, sometimes with very high surface temperatures. As part of their duties, some dogs are required to walk long distances with military patrols. Therefore, it is important that the VCO appropriately diagnose and manage patients with these injuries, both for the welfare of the dog and for its prompt return to duty. Some of the more extensive foot pad injuries can require > 1 month to heal enough for a dog to work effectively without signs of discomfort and return to full duty. In the authors’ clinical experience, healing can be prolonged because of the kennel environment in which these dogs live. Because of the extensive kenneling requirements, almost all MWDs with these injuries require bandage or splint management, protective collars, and multiple recheck examinations, placing a large demand on human and physical resources that can have limited availability, as well as taking the dog out of the mission. Some dogs have been deployed with protective footwear (or boots) in an attempt to limit foot pad injuries. In the authors’ experience, dogs often do not tolerate such equipment and have difficulties maneuvering efficiently over rough terrain. Dog handlers have anecdotally noted that when a dog is wearing boots, it can slow the progress of patrols and potentially make the team less effective. Further work needs to be done to determine whether additional training with protective footgear prior to deployment would enable a dog team to be more proficient.

Tail tip trauma can consume a large amount of professional and technical time to manage each case. Treatment includes superficial wound management and behavioral modification but can also include caudectomy if medical management is unsuccessful.13 Tail tip trauma problems are occasionally seen in pet dog populations and more commonly reported in racing greyhounds.14 The problem primarily arises in working dogs because of the small size of kennel facilities and a propensity for the dogs to spin in their kennels. This spinning motion causes the tail to repeatedly hit against a hard surface and ultimately causes chronic blunt trauma to the tail tip.

Musculoskeletal diseases are a known cause of morbidity and a leading cause of euthanasia of MWDs.15 These dogs have training and work requirements to search in high locations, where the dog must stand on its hind limbs in an upright position. Patrol training requires the dog to jump frequently at personnel in protective suits and arm wraps in a repetitive manner. Studies should be performed to determine whether this places additional strain on the hind limbs and the lumbosacral junction of MWDs. In our data set, it was not possible to review and interpret the medical records to determine whether the onset of hind limb lameness was associated with neurologic signs. Only 4 patient evaluations were associated with previously diagnosed lumbosacral disease. The MWD population that is considered deployable is cleared by their home duty station veterinarian as obviously healthy with no signs of uncontrollable disease. Some dogs are regularly administered NSAIDs, but to be deployable, their condition must be considered adequately controlled. Generally, most musculoskeletal system–related visits were managed conservatively, with empirical antiinflammatory treatment and rest. Dogs that could not return to duty were returned to their home duty station.

Six specific conditions, despite comprising only a small percentage of the total cases of noncombat injuries and illnesses, occur frequently enough in the MWD population that they are worth specific mention16: foot pad injuries, tail tip trauma, scrotal dermatitis, explosive agent ingestion, gastric dilatation–volvulus, and chronic superficial keratitis (pannus). Additional training on these topics could be of benefit both to VCOs and to their patients.

There were several limitations to the present study. The data were obtained for a short period of time (20 of approx 105 months [March 2003 to December 2011]), considering the duration of the conflict. The theater of operation was very mature at the time of the study, with hardened structures for kennels, advanced veterinary medical facilities, and robust logistic operations, and therefore, the results may not be reflective of other operational phases. Data were also only available for MWDs in the country of Iraq, and results in other regions may differ. Information available prior to January 2009 only included the number of patient encounters and whether these involved noncombat-related injuries and illnesses, combat-related injuries, or physical examinations and health certification. No data were available to verify the specific nature of any of the patient encounters or confirm the reported clinical signs or diagnoses because of the inability to investigate the medical records, and associations with factors such as age, breed, sex, duty type, housing, and handler experience could not be evaluated. Clinical outcomes could not be assessed because of the lack of follow-up data. Finally, because of information security requirements, data were reported on the basis of the number of patient encounters rather than the number of dogs, and this should be considered when interpreting the results. Additional studies are needed to determine whether the reasons for veterinary visits (other than combat-related injuries) for deployed MWDs are similar to those for dogs seen at home duty–station clinics.

It is understood that veterinary teams in areas of active conflict must be well versed in as many forms of combat-related trauma (eg, gunshot wounds and blast injuries) as possible. Our results support that the veterinary team must also remain proficient in management of common disease processes of the dermatologic and alimentary systems, common soft tissue–related injuries or illnesses, and musculoskeletal system.

Veterinary Corps officers and animal care specialists assigned to Medical Detachments Veterinary Service Support units do not work in a clinical setting during daily operations. A large amount of their time is spent planning field training exercises, coordinating mandatory training events, and managing personnel issues; however, it is important that there is adequate time allotted for maintaining veterinary medical and surgical proficiency. This could be aided by a working agreement with the local veterinary treatment facility that would enable VCOs and animal care specialists to routinely examine patients with clinical signs of injury or illness, conduct follow-up care, and perform various surgical procedures. This can help ensure that veterinary teams maintain a sufficient level of technological experience and proficiency, especially in the identified areas.

ABBREVIATIONS

MWD

Military working dog

VCO

Veterinary Corps officer

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