Category Archives: Techniques & Tips

K-laser, and red light therapy is not Voodoo!

You may not have been exposed to it, ever, or just not yet. It’s a technology called K-laser, or red light therapy. It’s the direction of intense red light of a particular wavelength (680nm) (Here’s one of those lights) at the damaged cells in a surgical or diseased area of the body. Until they know how it works, people have a tendency to think it is nothing but snake oil but once you understand how simple it is, you will just be amazed. It is based on the identical chemical reaction that powers lowly algae.

“Erik, we have been doing the K-therapy since last Thursday morning. It seems to have helped her, and my aching thumb feels better. I am able to play guitar again. Go figure. Thanks for the suggestion.”

Koi Fish and Injections of Antibiotics 

Starting Off: Injection Fundamentals

Koi Fish and Injections of Antibiotics

Injections may be the only way to save the bacterially infected fish that will not eat. Soaking the infected fish in a bath of antibiotics is a last resort, but will not USUALLY save valuable fish lives.

I strenuously recommend that you obtain the necessary injectible antibiotics and the syringes and needles, and commence injections immediately. Baytril (Enrofloxacin) performs well, and is safe in various degrees of overdose. Enrofloxacin is also good because dosing can be spread out to every third day and it still works.

Nuflor (Florfenicol) is also well accepted and works, with only one injection, because it is oil based.

Koi Fish and Injections of Antibiotics 
Koi Fish and Injections of Antibiotics

Injection of Koi and other ornamental fish should be undertaken only when the risks are weighed against the benefits. There is (arguably) a 5% chance that a fish will be injured or die when injected, even with a safe drug. With experience, the percentage drops dramatically. I recommend use of a 1cc tuberculin syringe. Needle size is best at 25 gauge, 3/4 inch length. Catch the fish as un-stressfully as possible. If the fish is laboring in the net, let him go and try again later. You can wrap a fish in a plastic bag with the water let out.

Koi Fish and Injections of Antibiotics 
Koi Fish and Injections of Antibiotics

Insert the needle at an angle, aiming through the fish as if to emerge at the mouth, going in just behind the ventral fins, but well in front of the anus or vent. Quickly depress the plunger and withdraw the needle.  You will usually pull a scale out when you inject a fish. You can put your finger at the spot the needle goes in, to hold the scale but it’s okay if a scale comes up.


That is a significant misunderstanding by some folks, that has then been taught to others! It is the PELVIC fins that define the injection anatomy! When you inject in the base of the pectoral fin, you may be told that this avoids liver filtration of the antibiotic. Turns out, this is NOT true and has been disproven over five years ago. Worse, injection near the pectoral fin is within a short distance from the heart and gall bladder. The pectoral fin is one of the most important fins for navigation and messing it up has a real impact. This is a VERY risky place to inject a fish.

But, I’m hardly in a position to argue the point with some super-knowledgeable elderly guys on a bitter UK Message board, as much as they know from their reading – what does my hands-on experience count for?

Fish Antibiotics Survival Medicine

Any Skin Case Can Be Fixed

It’s important that you know I’m not being sarcastic when I say I can fix (almost) any skin case.

I’m being serious; but I’m also discounting the fact that some of what I am saying may come at the expense of the pet, or at the expense of your wallet. Specifically, I’m talking about giving antibiotics and steroids to dogs with itchy, infected skins and they do well. For a month.

Or, sending you to a dermatologist who gives your pet four medications, a shampoo and a new food to eat: Limited antigen diets, antihistamines, antibiotics, Bravecto or similar, Apoquel, and a shampoo with antifungal and antibacterial properties. Which translates into, literally, treating for everything.

The dermatologist route (as listed above) flawlessly addresses:

  1. Ringworm
  2. Bacterial pyoderma
  3. Mange mites, dermal and intestinal parasites
  4. Allergies both topical and dietary
  5. Atopy

Besides skin cancer, nothing else happens that wouldn’t respond to the above.

Here’s the skinny on why we might be doing something “in between” with antibiotics, a cortisone and some Cytopoint.

ITCHY SKIN CRASH COURSE_drjohnson_com_simpleskin



Levamisole for Camallanus Intestinal Worms in Koi and Fish

Levamisole can be added to the diet at 0.1% of the amount and fed for 7 days for removal of nematodes.

Tramisol Levamisol for Worms in Koi
Levamisole (Tramisol) – by Doc Johnson

Levamisole for Camallanus Intestinal Worms in Koi and Fish
Levamisole for Camallanus Intestinal Worms in Koi and Fish

As a water additive, Levamisole Phosphate can be used effectively as a dewormer for Goldfish and Koi, among other species, as an indefinite and safe treatment. The dosage is 0.5 ppm (zero- point-five PPM) added directly to the system without impediment to the filter or fish.

Levamisole / Tramisol will NOT KILL FLUKES

“Almost any veterinarian can and will get Tramisol if you ask nicely.” ~ Doc Johnson

Goldfish and Aquarium Fish. Free PDF

Dosing Levamisole for Camallanus and other Intestinal Worms in KoiGoldfish and Aquarium Fish. Free PDFDosing Levamisole for Camallanus and other Intestinal Worms in Koi



Identification and Treatment of Acral Lick Granulomas – Acral Sores

This is an acral lick granuloma except it’s not acral ha ha ha ha  this one’s on the hind foot, but it’s in a very typical location. An acral granuloma is a patch of scar tissue that a dog won’t allow to heal. So they lick it because it tingles, according to people who have them. Sometimes they lick them out of anxiety, out of habit, and our of boredom. However they’ve also found that antibiotics can help heal the skin, but the problem is that when you stop the antimicrobial, the lesions come back. So, many of the dogs often live in cone-collars.

There is a way to heal these faster dripping insulin (straight up) onto the lesions and wrapping the foot in Press-n-Seal and a wrap to keep the insulin against the skin, and keeping the insulin from drying out. Healing rates double. But you still have to keep the dog from licking the lesions. That’s the basis of all success.

I’ve removed these lesions in the past, and wasted money with the formation of a new one at the surgery site, so don’t bother.

I’ve injected steroids under these, and it helps. But they only heal halfway and then regress. Don’t bother.

I’ve frozen these lesions and that ruins the skin, sets the granulomatous tissue back, numbs the lesion but as soon as the lesion heals from the iatrogenic frostbite, the dog’s back to it. It never is actually better, it’s just ‘a lesion’ of a different type for a week.

Wraps are good. Cone collars are good. Antibiotics are good. Insulin topical under Press-n-Seal is good. You can even emulsify the insulin into NeoSporin (keep refrigerated after) to make the insulin “stay on” longer.

Anti-anxiety medications are making a break into management of the acral lick granulomas. Elavil, Amitryptilline, Prozac, even CBD/THC are often effective. Even if anxiety and habit are only HALF the problem, it’s worth a try. Not very expensive.

And according to the article I’ve attached to this post, they’re having some luck with red lasers, which cause activation of healing components in the skin. A mitochondria is ‘activated’ by ‘sunlight’ and even moreso by artificial wavelengths, for example 600-700nm. Near infrared. So they’re using light-therapy and getting some healing.

I think the best approach would be something like Fluoxetine or Clomicalm, PLUS an antibiotic (to be on the safe side) and a cone collar.  The topical of choice would be Cetafil  cleanser wipes and then light-therapy as mentioned above.

Side note: I’ve seen Claro used on these lesions, it’s less-than-fabulous.

Doc Johnson

Lick granuloma – Wikipedia


Fish Surgery by Dr. Erik Johnson

During the natural expansion of veterinary medicine into the world of Koi – it was inevitable that sooner or later a fish would require surgical intervention. When called upon to do this in the mid nineties, the road was not paved with much information for me, and we lost a fair number of fish just developing safe and useful anesthesia. After we had the fish living through anesthesia, we had to work out all the issues of surgery. So it’s been a long road.

The most common cause for surgery on fish is the repair of damage or infection to the mouth, enucleation, removal of tumors on the skin, suturing wounds, and exploration of the abdomen. If you think about it, there’s lots of things that might require surgical intervention when it comes to fish. It can make a big difference to quality of life, and even to survival.

Why (under what circumstances) do people do this for their fish?
Not many people even have surgery for their fish. Koi *can be* expensive but that does not mean they all are. And not all people are as attached to fish as they might be to a dog or cat. More importantly than economic or sentimental “value” – folks frankly doubt that there’s anything that can be done – so opportunities are missed. I used to perform surgeries on fish in the Atlanta area at no cost to the owners. So economics were largely removed from the equation. Still, surgeries are comparatively rare because people are reluctant to actually go to the trouble.

The problem with fish surgeries was that people would bring fish for surgery by the time they “had nothing to lose” and the fish had used up every bit of reserve strength and the tumors and problems were VERY advanced.

If a fish is injured, or has an abdominal swelling which might be a surgical target either for its diagnosis or removal, the owner would make contact with the office in Marietta and arrange to ship the fish or carry the fish to my office.

Do all vets do fish surgeries?
Not all vets practice fish medicine. Exactly the same way I don’t practice on horses or birds, so some veterinarians do not work on fish. It has to do with expertise and passion. Fish are important to me as pets and I “like” them. Other vets prefer horses in a similar way. This defines our training and our allocation of time. There is a growing list of veterinarians who practice fish medicine. 

Do I have to ship my fish to you for the surgery?
Sometimes you can find a veterinarian who will perform fish surgery. Of these, a growing proportion will be able to provide you with surgical services. There is a diagnostic process to determine if surgery is even indicated for your fish. Past that, you can find help locally if you’re lucky.

And if I do have to ship a fish, how do I package and ship them so they survive?

The highlights of shipping are as follows.
First, never ship the fish until or unless you’ve actually spoken to someone on the receiving-end to make sure that they’re in town, ready to have the fish in the clinic, and ready to do the surgery. It’s also important that you ship the fish in a large plastic bag with about 30% water (enough to cover the fish) and 70% oxygen. The oxygen needs to be pure, 100% oxygen from a tank, not room-air. Fish will NOT get here alive packed under room air. I promise. And the air should take up more space in the bag than the fish or the water. But there should be enough water to cover the fish.

Finally, make sure the bag is not “taut” with oxygen – the bag should be “mushy” because when the airplane cabin pressurizes in flight, the bag will expand and become taut – and if you’ve packed it tight with oxygen, it will pop – and the fish will be lost. Make sure to close the bag with TWO rubberbands and then overbag it in another plastic bag with TWO rubberbands. Those are the highlights. The website talks about the shipping type, time of day to drop the fish off, and how to talk to Fedex to get what you want! <grin>

Are the fish underwater during surgery?
That’s a good question – at first they are underwater. We have the fish in a holding vat with room-temperature water, well-aerated. The anesthetic we use is mixed well, and then put into the tank with the fish. When the fish falls asleep, we then use a pump to push water over the gills – we re-use the water with the anesthetic in it over and over for the fish we’re trying to keep asleep. After the procedure of course, we throw that water out. The fish is then replaced in clean, pond water.

What kind of anesthesia medication is used?
There are two kinds of anesthesia we use. The best one seems to be Oil of Cloves, because it’s easy to get, and it brings the fish down and back up again rather slowly, allowing more careful monitoring. Fewer accidents occur when the fish is moving through its anesthetic planes slowly. You should emulsify the oil of cloves in a small jar of water – shaking it violently to mix it, then put it in th e tank with the fish you want asleep.
The second anesthetic is MS-222 also known as Finquel. It works very well. But it’s harder to get – and you need to buffer the water in which the fish is sleeping with Baking Soda. When you determine the amount of Finquel you need, you must use THREE TIMES that much Baking Soda in the same water to sustain the pH while the fish sleeps.

Is there a recovery, post op sort of thing similar to a human surgery?
After surgery, the fish is returned to clean clear water, usually the tank it was in before surgery. If Oil of Cloves was used for the anesthetic, we might expect the fish to require about ten minutes to wake up, but that’s actually dependent on three things. How strong the fish was, what temperature the fish is, (colder takes longer to wake up) and finally, how long the procedure was. (Longer time “out” requires more time for waking up!)
After surgery, since we’ve opened the skin, infections are common. Think about it. We can’t really “bandage” the wound, and your doctor would FORBID you to swim after surgery because water can’t be sterile. So bacteria are always getting into surgical wounds so antibiotic therapy becomes very important after surgery. This is usually provided via injection.

How long do they stay at the vet after the surgery?
We’ve had most of our fish go home the same day for minor procedures because the owner usually has dedicated space for the fish post operatively. Also, it’s a fact that the owner will monitor more closely than we ever could – after all, the owner can be there all night, all day if need be! In any event, we encourage the owner to continue antibiotic therapy at home, and do whatever is necessary to get a surgical patient eating again! That is VERY important to surgical success.

Do they get stitches? Do they come back to the vet for a followup checkup after surgery?

If we have placed stitches in the fish, these stitches are supposed to be removed thusly:
Day Four or Five: Remove every OTHER stitch and check the incision line for sealing.
Day Seven or Ten: Remove every OTHER stitch again, leaving very few in the line. Check for sealing.
Day Fourteen: Remove all stitches.

We have found that stitches in the skin are VERY irritating and the faster you can get them OUT but STILL have the fish “closed up” the better they do.
And we have found that you should NOT REMOVE ANY stitches if the line gaps at all when you’re considering the removal of any stitch.

Hatching Geochelone Denticulata Breeding Yellow Foot Tortoises

Hatching Geochelone Denticulata (S.A. Yellowfoot Tortoise)

This is a pan-shot of the 15 gallon aquarium I modified into an incubator. A thermometer over the water bath shows 82-87 degrees. The eggs are on fluorrescent “egg crate” about two and a half inches above the water’s surface. The water bath is 90 degrees. The airspace the eggs are in is 82-87 degrees.

 The top of the incubator is a piece of insulating sheathing. I figured since it is fish safe, it is also probably tortoise safe. There are two gaps in the top which I could adjust to have more humidity, more heat, or less of either.

The filter is a simple sponge filter powered by a 600/L/Hr pump. I used this very same type of system to keep some Sulcata hatchlings warm last winter and it worked great, but the water fouls if not filtered. The heater is reliable and runs the water at 90-92 giving me a 82-88 degree airspace.

Now, here is my point of worry, and I need your advice. There’s water condensing on the sides of the airspace. This would suggest almost 100% humidity. However, the eggs (since they are inside and isothermic with the air around them) have no condensation on them at all. Given the high humidty, will they still dehydrate? No forced air is used. –> (The eggs hatched fine with the condensation on the glass)

Detail of two of the six eggs I got 9/7/98 midnight. They were laid by the female in sphagnum peat moss which was bone dry, but I found them AS THEY WERE LAID. I took them out of the nest so they would not get broken. They are very large. I rinsed them by running them under poured, distilled water. They were never submerged or sprayed under pressure.

The tops of the eggs are marked with X’s in plain pencil and they are stable and will not be turned.


* Should I spray them daily with distilled water?
(I did)

* Do they (as with some snake eggs) need to be kept in the dark, or is lamp light okay to monitor them by?
(Mine were kept in indirect lamp light from the room)

* Will the tanks’ humidity avoid dehydration or should they be on a papertowel to hold moisture? How moist is “too moist” which causes rot?

(These eggs were on egg-crate and not on any porous surface)

* Does anyone know the true incubation period (variables notwithstanding) of the Yellowfoot tortoise?

Glargine, Lantus, Use in Cats For Diabetes Mellitus

Using Glargine In Diabetic Cats (June 2006)
Rhett Marshall BVSc MACVSc1,2,
Jacquie Rand BVSc DVSc Dip ACVIM1
1Centre for Companion Animal Health, School of Veterinary Science,
The University of Queensland and
2Creek Road Cat Clinic, Brisbane, Australia.

These instructions for using glargine are based on a relatively small number of cats, and caution should be exercised with the insulin until it has been used in an extensive number of cats. Because glargine is very long-acting, there is the potential for prolonged hypoglycemia if overdosed.


Glargine (Lantus) is readily available from most pharmacies with a script, is not licensed for use in cats.
Glargine must not be diluted or mixed with anything because the prolonged action is dependent on its pH.
Insulin glargine should be kept refrigerated to prolong its life.
Insulin glargine has a shelf-life of 4 weeks once opened and kept at room temperature. Opened vials stored in the refrigerator can be used for up to 6 months.
Discard vial immediately if there is any discolouration. Bacterial contamination and precipitation associated with pH change can cause cloudiness.
If using an insulin pen, the manufacturer recommends that the pen and cartridge be kept at room temperature and not refrigerated. This is to reduce the changes in volume of insulin dispensed associated with changes in temperature.
When performing a blood glucose curve, samples probably only need to be taken every 4 hrs over 12 hrs in many cats (ie. 0h [before morning insulin], 4h, 8h and 12h after morning insulin).
Dose changes should be made based on pre-insulin glucose concentration, nadir (lowest) glucose concentration, daily water drunk, and urine glucose concentration.
Better glycemic control is achieved with twice daily dosing rather than once daily.

Some pharmacies stock insulin syringes (Wal-Mart) with gradations in ¼ U, which are ideal for cats.
Some cats that have been treated with other insulin will go into remission, usually within 1-4 months after instituting Glargine. Remission in cats that have been treated for more than 2 years is extremely rare.
Remission is likely to occur if the nadir glucose is in the normal range and pre-insulin blood glucose is less than 216 mg/dL (12 mmol/l). However, for some cats to achieve remission, the dose needs to be very gradually reduced, tapering off to ½ U SID before being withdrawn. Too rapid withdrawal often requires restabilizing at a higher dose for some weeks.

All newly diagnosed diabetic cats (to increase chance of remission).
Poor controlled or unstable diabetic cats (glargine’s long duration of action is likely to benefit these cats).
When SID dosing is desired or demanded (it is important to note that better glycemic control and higher remission rates will be obtained with BID dosing. SID dosing only provides similar control and remission rates to lente BID).
Ketoacidosis – combined with regular insulin IM or IV.
When corticosteroid administration is required in cats in remission. Similarly in cats at high risk of developing clinical signs of diabetes with corticosteroid administration.

If blood glucose conc. > 360mg/dL (20mmol/L) begin glargine at an initial dose of 0.5U/kg ideal body weight twice daily (BID)
If blood glucose conc < 360mg/dL (20mmol/L) begin at 0.25U/kg ideal body weight BID
Perform a 12hr glucose curve with samples taken every 4hrs
DO NOT increase dose for the first week
Decrease dose if biochemical or clinical hypoglycemia occurs
It is suggested that cats stay in hospital for 3 days to check the initial response to insulin, or home glucose curves are obtained for the first 3 days
Recheck at 1, 2, 3 and 4 weeks after the cat is sent home, and then as required
Many cats have negligible glucose lowering effect in the first 3 days (do not increase dose), although by day 10 after beginning insulin, most cats have good glycemic control
Ketoacidotic cats may be treated with glargine s/c at the above dose rates in combination with regular insulin IM or IV (we have found IU regular insulin IM every 2-4 hours based on glucose conc works best). This regime is continued until hydration restored and appetite reteurns, which usually occurs in 1-3 days.

1. Indications for increasing dose of glargine

If pre-insulin glucose conc. is >216mg/dL (12mmol/L), then increase dose by 0.25-1 U/injection depending on the degree of hyperglycemia.
If nadir (lowest) glucose conc. is >180mg/dL (>10mmol/L) then increase dose by 0.5-1 U/injection.
For well controlled cats after several weeks of therapy, increase dose if nadir is more than or equal to 8 mmol/L (145 mg/dl).

2. Indications for maintaining the same dose

If pre-insulin glucose conc. >180 – <216 mg/dL (>10 – <12mmol/L)
If nadir glucose conc. 90-160mg/dL (5-9mol/L).
For well controlled cats after several weeks of therapy, aim for a nadir of 72 -145 mg/dL (4-8 mmol/L)

3. Indications for decreasing dose of glargine

If pre-insulin glucose conc <180mg/dL (<10 mmol/l) decrease 0.5 – 1U
If nadir glucose conc < 54mg/dL (<3 mmol/l) decrease 1U
If clinical signs of hypoglycemia develop, administer 50% glucose IV bolus followed by 2.5% glucose infusion, then reduce dose by 50% and check for remission.
If clinical hypoglycemia develops and is not severe, it can often be managed by feeding the cat, preferably a higher carbohydrate containing food, such as a some dry foods. However, it must be palatable enough to eat. Most weight reducing and renal diets are high carbohydrate diets, as are many grocery lines of dry food.
For cats with unexpected biochemical hypoglycemia (not clinical signs), some owners find that they can manage the hypoglycemia by delaying the insulin injection until blood glucose increases to 10 mmol/l (180 mg/dL) and then give the same dose (the following dose of insulin may need to be reduced), while others find it best to reduce the dose once glucose is 10 mmol/l (180 mg/dL), although this may result in subsequent hyperglycemia.

4. Insulin dose may be maintained, increased or decreased depending on the water intake, urine glucose, clinical signs and length of time the cat has been treated with insulin

If pre-insulin glucose conc. 198 – 252 mg/dL (11 – 14 mmol/L), or if nadir 54 – 72 mg/dL (3 – 4 mmol/l), clinical parameters are essential for adjustment of insulin dose.

Insulin dose should be gradually reduced by ¼-1 U/cat/injection if nadir blood glucose is in the normal range of (72 -126 mg/dL; 4-7 mmol/L) or either pre-insulin glucose concentration is < 10 mmol/L. Slow withdrawal of insulin is advocated until dose is ½ – 1 U once daily (SID).
After a minimum of 2 weeks of insulin therapy, if the pre-insulin blood glucose is < <180mg/dL (<10mmol/L) and insulin dose is ½-1 U SID, insulin should be withheld and a 12hr glucose curve performed. If at the next due dosing time the blood glucose is >200mg/dL (12mmol/L), then insulin can be administered at 1U BID and then gradually reduced as indicated. If blood glucose is <200mg/dL then continue to withhold insulin and discharge with a follow-up visit in 1 week. Water intake and urine glucose should be closely monitored and insulin reinstituted if glycosuria returns or water intake increases.
Some cats may have a pre-insulin glucose concentration below 10mmol/L (180 mg/dL) within 2 weeks, but insulin therapy should be maintained for a total of 2 weeks to give beta cells a better chance at recovery from glucose toxicity. Use 0.5-1U BID or once daily until insulin is withdrawn


With the long duration of action of glargine, there should be minimal periods when blood glucose is >14mmol/L (240mg/dL) for cats treated for more than 2 to 3 weeks, and hence well controlled cats should almost always be 0 or 1+ for urine glucose. A value 2+ or greater likely indicates that an increase in dose is required.


For some cats, the dose needs to be increased to 5 or 6 U/cat BID, but can then usually be reduced as insulin sensitivity returns. Cats on these high doses need to be carefully monitored for hypoglycemia.
Some cats require only small doses of insulin (<1 U/cat BID) and only go into remission if the dose is reduced very slowly giving few remaining beta cells a chance to recover.

For many cats, the time at which the nadir (lowest) glucose concentration occurs is often not consistent from day to day, or between cats. Sometimes it occurs somewhere between the two doses, but sometimes the nadir occurs around the time of the next dose.
Most commonly the highest glucose concentrations occur in the morning and the lowest in the evening.
Some cats consistently have their nadir glucose concentration in the evening just before the next insulin injection, and less commonly, it occurs around the time of their morning injection.
To increase the chance of remission, we suggest aiming for perfect control or possibly slightly overdosing during the first 2 months, provided the veterinarian and owner can carefully monitor the cat. There is the potential risk of hypoglycemia, but we believe this is outweighed by the benefit of diabetic remission to the cat and owner.
Cats requiring intermittent or chronic corticosteriod administration that are either in remission or at risk of developing diabetes can usually safely be placed on IU SID or BID.
It is a very common observation by owners that when long-term stable diabetic cats are changed over to glargine, usually they do better clinically, even if blood glucose results do not support the clinical improvement.
More information on glargine and general information

How To Raise a Pretty Good Puppy

How To Raise a Pretty Good Puppy

Well, how to raise a REALLY good puppy. I learned a mess of stuff about caring for puppies over the years, because I saw what people did right and did wrong, and so I made this two page document. I think what’s happening these days is that people are coddling the dogs too much. That’s NOT to say you need to be mean, in the slightest. The only time I’m ‘mean’ to Ajax is when he does something that could jeopardize his security. He was NEVER allowed to growl at anyone. He could never curl a lip at anyone. He was trained with a training whistle to come when called regardless of what he was doing. And he’s 100% amazing. Here’s how:


Pantene Pro V Conditioner Made Into a Spray For Moisturizing Dog Skin

You can mix Pantene Pro V conditioner in warm water and a spray bottle, shake VERY well and then you can spray that on any medium to short coated dog to moisturize the skin during heat-stress and other atopic times. This document describes how to mix it, exactly what and when.