Henry

Photo by Riis Williams

Henry wore a standard Elizabethan collar for more than three weeks recently after having tumors removed from a leg and his torso. His owner said Henry was a good sport about it.

Vanessa Waltz was at her wit's end after her veterinarian issued an Elizabethan collar to her dog, Ringo. The 8-year-old, 66-pound dog had developed two skin lesions on his left front paw from obsessive licking. Elizabethan collars, often called "cones" for their shape, encircle a dog or cat's neck to keep them from licking or chewing on a wound, surgical site or irritated skin.

Like many pets, Ringo didn't like it, and he expressed his dislike openly.

"He quickly learned to use the cone as a weapon, bashing into us violently and intentionally knocking things over," Waltz said. "It may sound like I'm anthropomorphizing him, but absolutely not — like, he'd make a beeline to something like a plant stand and bash his head into it, knock it over and bark."

Waltz, who lives near Santa Fe, New Mexico, attempted to meet him halfway with a sock and veterinary bandaging. That intervention, too, was short-lived. She posted pictures of a woeful Ringo and the shredded bandage on Facebook with a ditty:

It leaves the bandage on its shin
Or else it gets the cone again.

Waltz's friends offered sympathy and ideas, but it was the suggestion by an emergency veterinarian of an inflatable collar shaped like a doughnut that finally stopped Ringo from chewing his foot and destroying Waltz's home.

Elizabethan collars, fitted to the neck and flaring outward past the nose, are named for the elaborate neck ruffles that were de rigueur among the English upper class during the 16th- and 17th-century rule of Queen Elizabeth I. The veterinary collars have long been the go-to method for preventing dogs and cats from licking or chewing surgical wounds and other healing tissue. They've been in use in some form for more than 100 years — a paper published in 1961 referenced the historical use of buckets, with the bottom cut out, placed over an animal's head and lashed around the neck. Lighter than the metal, wooden or leather devices of yesteryear, today's rigid plastic collars still cause consternation in owners and pets alike, triggering the nickname "the cone of shame." Countless memes and social media posts feature hapless pets getting stuck in doorways or sideswiping people and furniture as they try to go about their normal activities.

It's no secret to veterinarians that many pet owners dislike the cone. Dr. Anne Quain (formerly Fawcett) for years sent surgical patients home with cones, knowing full well they weren't welcomed. "I did understand from feedback from clients that they were perceived to be stressful for the animals," she said. "They were certainly stressful for the owners."

It wasn't until Quain, an animal welfare and behavior specialist with a doctorate in veterinary ethics at the University of Sydney, had a personal experience with the cone that she focused on it for a formal study, resulting in a paper published in 2020.

"It was a deeply personal mission motivated by the experience of living with a dog wearing an Elizabethan collar for three hellish weeks," Quain recounted. Her then 16-year-old Chihuahua Maltese cross, Philip, who'd undergone cataract surgery, made it clear he despised the cone.

Quain set out to document pet owners' experiences through an online survey of those whose pets had worn an Elizabethan collar during the previous year. The results confirmed anecdotal reports she had heard for years about the impacts on pets' quality of life.

Almost two-thirds of the 434 respondents said their pets, when wearing the collar, had trouble drinking, and 17% couldn't drink at all. Another challenge was navigating the home environment, with pets crashing into doorways and furniture or unable to use stairs. "It hurts when they slam into your legs," one dog owner offered. Eliminating, whether outdoors or in a litter box, was difficult for some animals, and frustration over the inability to self-groom was especially noted in cats.

About a quarter of participants reported pets being injured by the collar, most commonly rubs and irritation. A few tumbled down stairs or fell off furniture. Several owners reported challenges fitting the collar to their dogs' conformation, especially sighthounds with their slim bodies and long noses, and short-legged ones like dachshunds and corgis.

However, cones check several boxes for veterinarians and pet owners seeking to protect an irritated zone: They're inexpensive, they fit most pets, and, when pets tolerate them, they are effective.

Cone alternatives have begun proliferating. Some, like cloth or felt cones, modify the original design for patient and owner comfort. Others take a new approach, such as inflatable "doughnut" collars or flat and wide rigid collars that limit a pet's range of motion in the neck. These designs prevent patients from being able to lick or chew the belly or hind limbs but don't stop maneuvers like scratching an ear or wound on the head with a hind leg.

Bodysuits, also called recovery or surgery suits, are becoming more commonplace. They cover the trunk and sometimes the limbs, providing a physical barrier. Determined pets might saturate them by licking or chewing holes in them, though.

Ringo_bandage

Screen shot of Facebook post

On social media, Vanessa Waltz documented her struggles with protecting Ringo's paw from his incessant licking.

Making friends with the cone

Dr. Christine Calder, a veterinary behaviorist in Maine, advises that pets can be trained in advance of elective surgery to become desensitized to cones. Even better, she said, is routine training for puppies and kittens to accept and tolerate the cone.

"I think every dog or cat can learn to wear a collar," said Calder, who is director of behavior educational content at the Veterinary Information Network, an online community for the profession and parent of the VIN News Service.

One technique involves placing the cone on the floor, wide side down, and surrounding it with a few treats to encourage pets to investigate it on their own. Once the pet is comfortable with the presence of the cone, place the treats inside so the pet has to move it to reach the reward. Next, hold the cone in one hand and offer treats in the other, so the pet can access them only by putting its head through the narrow end of the cone — set wide enough that they can easily back out if they want to. Pets should see this as a fun game as they progress to wearing the cone, first while stationary, then while walking. The time it takes for a pet to fully adapt to the cone varies by temperament and previous experiences.

Calder used target training — teaching a pet to touch an object with its nose on command — on her own dog to teach him to put his head into spaces such as a deep bowl or muzzle. When he was neutered, "we started with the surgery suit, but he chewed a hole in that, so we went to the cone, which bothered him zero," she said, thanks to his early training.

While structured plastic cones are the standard go-to method for preventing pets from hurting themselves, they are not without their own risks. Both Calder and Quain identified the potential hazards of rigid plastic cones, particularly with cats. "Cats often get their jaws caught in the cone itself," Calder said. Fabric or otherwise soft, more flexible cones may work better for and be more accepted by cats, she said.

Cone types

Photos by (clockwise from top): Melanie Yarbrough; Dr. Megan Ward; Shy Lalumiere courtesy of KAMsnaps; Vanessa Waltz.

At top, Odin wore a bodysuit following neutering. Lower right, littermates Star and Robin were outfitted in standard rigid Elizabethan collars after desexing surgeries. Lower left, a dog modeled a homemade soft cone. Middle left, after strongly protesting a standard cone and shredding a sock and bandage meant to stop him from licking lesions on his front paw, Ringo succumbed to an inflatable doughnut collar.

Quain said, "Whatever we use to protect their surgical site, we need to make sure it doesn't become a foreign body [and] that it doesn't cut into them, it doesn't choke them, it doesn't inhibit them from breathing if they push it back."

She described a survey response from a pet owner in Canada whose dog ran through the snow, and the cone filled up as if with ice cream. "That sounds funny, but if it's not supervised, that's quite a hazard," Quain said.

She found that several pet owners took matters into their own hands in fashioning alternatives to the Elizabethan collar, including using pool noodles or a travel pillow to make a temporary doughnut collar, or T-shirts as makeshift bodysuits. (Similarly, soft cones, which can be worn forward or inverted, come in homemade as well as commercial forms.)

Some owners opted for bandaging the area, which can carry its own risks, such as impairing circulation if wrapped too tightly around a limb or leading the dog to lick, chew and possibly swallow the bandage material. Other owners requested sedating drugs from their veterinarian to ease their pet through the toughest parts of recovery.

Bodysuits rank well in recent research

A study published in January found that surgical recovery suits are equally as effective as, if not more than, an Elizabethan collar.

The study involved 26 cats that were spayed at a university veterinary hospital in Turkey. After their operations, the cats were randomly assigned a rigid Elizabethan collar or a Lycra body suit. Researchers found the cats generally tolerated the suits better and had slightly lower pain scores at 48-, 72-, and 96-hour intervals after surgery, although the differences between the two groups were not statistically significant. The researchers posited that the gentle compression of the suits alleviates post-surgical pain and provides a quicker return to the cat's baseline comfort level. They noted that this idea requires further study.

Dr. Leslie Wolff, a veterinarian at a small animal practice in Wisconsin, offers clients a choice. "I show them pictures of the collars and the suits and ask them, ‘Hat or pajamas?' and I'd say about 80% of them opt for the recovery suits," she said, adding that they also tend to readily accept the slightly higher cost of suits.

Calder favors giving clients a choice. "I think it should be part of the conversations that veterinarians and technicians are having [with owners] as they come in for pre-surgical or even puppy and kitten visits," she said. "Is it a cone, a bodysuit, an inner-tube type of thing? Let's make sure they have the equipment ready for what they're going to need afterward."

Quain tried a visor, goggles and other cone alternatives to prevent her own dog from scratching at his eyes during recovery. But "he was so tiny … it was really hard for him to wear something around his face or head, because his head would just drop down with the weight," she said. "We tried lots of things, but, in the end, we stuck with the good old plastic Elizabethan lampshade collar. It was the lesser of all evils."

Following that pivotal personal experience, Quain took great professional satisfaction from studying the issue. "It was a chance to validate clients' experience," she said. "And I think there's a whole lot of areas in veterinary primary care where we could refine what we do just a little bit more, so our work has better outcomes for animals and for their people, and also is more joyful for us."