Patty Khuly

Dr. Patty Khuly practices in Miami, Fla., and blogs at dolittler.com.

Wellness: Health Care
Vet Advice: Help for the Chowhound
Gorging has its consequences—a cautionary tale

Question: Our dog is a notorious chowhound, and she's pretty indiscriminate about what she eats. Should we be worried?


Answer: Let me tell you about Goldie. Goldie is the kind of dog no one can resist for long. She hovers peaceably at barbecues, lays her head lovingly on guests’ laps during Thanksgiving dinner and generally makes a mild nuisance of herself whenever food is involved. Her imploring expression and gentle acceptance of rejection make it easy to forgive her, though.

As everyone who knows Goldie has learned, no degree of meticulous strategizing or human obstruction is enough to thwart a dog with an indefatigable nose for garbage. No matter where her owners stash it in an attempt to foil her canine impulses, Goldie’s a pro at unearthing people-processed trash.

After one now-notorious dinner party, Goldie slipped out the front door (no doubt as some inebriated guest departed) and was missing for hours. As it turned out, she hadn’t gone far. She was a mere few yards away, stealthily working her way through the garbage bin behind her house, gorging on the discarded contents of every diner’s plate. By the time she was discovered, her belly was bigger than a beach ball. Alarmed, her people rushed her to the emergency hospital to see what could be done to avert impending disaster.

An X-ray confirmed that Goldie had consumed a formidable number of carcass remnants and was thus ineligible for the effective—if undignified—emetic. (Vets don’t induce vomiting if sharp shards are present, since they can shred the esophagus on their way up.) Instead, she went home with stomach-protecting drugs and strict instructions to her family to fast her for a day and make sure she got plenty of rest.

She may have been spared nausea that night, but it wasn’t long before Goldie looked as though a truck had hit her—perhaps one loaded with the crustacean husks and Cornish game hen bones of the night before. Another X-ray confirmed that the bony material was in mid-digestion, most of it still in the stomach. The bigger problem, however, was the evidence of severe inflammation surrounding her stomach, upper intestines and pancreas.

Goldie didn’t have a fever and her blood work was normal, but it was obvious that she was in serious pain, and pancreatitis—a painful, life-threatening inflammation of the infamously sensitive pancreas—was high on the list of possibilities. Goldie was hospitalized and given IV fluid therapy, pain relief, antibiotics and more GI-protecting drugs. An ultrasound and consultation with an internal medicine specialist were also ordered.

Typically, vets allow even these extreme cases of garbage-toxicosis to pass—which they almost always do. Occasionally, however, when a dog has gorged to such a degree, more aggressive treatment is in order. This was indisputably the case with Goldie.

As gloomy thoughts of pancreatitis and the undigested matter loomed, Goldie’s vets summoned the surgeon. It was a hard call: gastrotomy or pancreatitis, or the inevitable bout of pancreatitis augmented by surgical pain. A gastrotomy surgically relieves the stomach of its bony burden, but the pancreas knows an insult when it sees one—and rarely veers off course once offended.

In spite of the risks, it was decided that Goldie should have surgery to remove the bulk of her midnight meal. Within 18 hours of its consumption, with the help of a heating blanket, four techs, one doctor and narcotics, she was recovering surprisingly well. Her family was sure she’d learned her lesson, but there’s no doubt in my mind that as she slept, her dreams were filled with visions of overflowing garbage bins and oceans of musty, refuse-ridden poultry carcasses.

The hazards of overindulgence—whether it’s the result of scavenging or human generosity—can be more serious than you might think. Dogs are notorious for the range of foodstuffs they’re willing to eat, and as Bark readers no doubt know, some of these items are dangerous, if not fatal. Chocolate, which is toxic, and high-fat or spoiled foods, which are triggers for pancreatitis, are to be scrupulously avoided. As Halloween and Thanksgiving approach, it’s a good idea to review potential food hazards on the ASPCA’s animal poison control site. Be extra vigilant, as not every dog will be as fortunate as Goldie!

PS: Goldie made a good recovery and continues to live contentedly with her now-vegetarian family.


Wellness: Food & Nutrition
A Vet's Point of View on the Pet Food Recall (2007)
A Guest Editorial

March was a rough month for us vets. Monday morning, the 19th, dawned to a deluge of frantic calls demanding answers. Um…what was the question? Most of us didn’t even know…yet.

I was asked questions like, “How do I know if my dog’s food is on the list?”, “What kind of tests does he need?” and the worst: “Is she going to die?”

It’s hard enough to say “I don’t know” under normal circumstances. This version went more like, “I have absolutely no clue.”

As one of my colleagues said, “I felt so stupid coming into work on Monday after a blissful weekend of … family time knowing absolutely zero about the recall. My clients probably thought I was a horrible vet.”

But how was this off-duty vet to know? So you understand, vets received no special notice before the announcement—made, by the way, on a Friday. As all news people know, the last day of the week is when you release an item you’d prefer to bury, not one you need to broadcast.

At this point, we know more about the now-infamous pet food recall that spawned the frenzy. Yet most vets on the ground continue to have more questions than answers regarding the toxins found in the affected pet foods, the pattern of exposure to our patient population, the practical considerations of treating this intoxication (poisoning by a toxic substance) and the reporting mechanisms required to aid in their investigation.
In other words, we’re still pretty clueless.

Where are the emails and bulletins from the pet food companies? Why has no helpful clinical information been provided to the distributors? Why were so many vets (busy reading their journals instead of watching the weekend news) blasted that Monday morning without so much as a warning?

Vets are hard-working people. We toil long in our lives, laboring to keep our animals comfortable and healthy—and yet things like this still happen. It comes as a blow, then, when all of our expertise and our acumen, channeled purposefully in the task of helping pets, yields the potential for their death and disease instead.

Sure, the pet food recall has shown us all how little we know about our food supply. Whether it goes into our pets’ food bowls or onto our own plates, we’re far less informed than we ever thought possible. But vets? We’re supposed to know about these things. People depend on us. Pets rely on our insider’s knowledge.

But, after the recall, we vets now understand how tenuous a grasp we’ve had on the information we get from pet food companies. We’ve trusted, just as you’ve trusted, in the veracity of their statements, in the wholesomeness of their foods, in their commitment to quality.

So, as a vet, I’ve got to confess that I’ve never felt more frustrated…and betrayed…and outraged.

My patients? In at least one obvious case, they’ve suffered. One chronically ill patient seemed to start feeling funny the Thursday before the recall. We prescribed her usual medications instead of requiring hospitalization. By Sunday, she was in acute renal failure after eating recalled pet foods for the previous month. Would a day have made a difference? Perhaps.

Any way you look at it, the time lapse in reporting the contamination was deplorable.

I can understand that some pet foods outsource their production. I can even understand purchasing contaminated grain unknowingly, but I cannot forgive the failure to report immediately the possibility of toxicity—to the public at large and to the vets they enlist to help sell their products.

How about one simple fax to every vet in the country? That’s not as hard to do as it sounds. They certainly know how to get to us when it comes to selling their food.

It’s bad enough that the manufacturer bought contaminated grain from a supplier. It’s bad enough everyone in the know sat on their hands for a month. Did they also have to display their disregard for pets so flagrantly as to fail to provide proper support for the vets who recommend their foods and to the people who feed those foods to animals they care for?

As a vet, I feel terrible. But however you see it, the pet food companies are directly to blame for the widespread mishandling of this crisis. These companies need to get serious about our pets. Better yet, if they don’t care enough to understand their importance, they should get out of the pet business altogether.


Wellness: Health Care
The Latest Word on Bloat
Vet advice on the right tack.

It’s the “mother of all emergencies,” as we vets like to say—the dreaded bloat, otherwise known as “gastric dilatation volvulus” or GDV. Fancy acronyms notwithstanding, this condition is as poorly understood as it is deadly. That’s why it’s worth re-hashing bloat’s gruesome details every so often. After all, science marches on, as does this emergency’s apparent inevitability and evasiveness. Here’s a quick rundown on what we do know:

• With bloat, the stomach twists, then fills with gas—or is it vice versa? Either way, the emergency comes in when the blood vessels that supply the stomach are pinched off. That’s when the organ starts to die, shock sets in and deadly cardiac rhythms can occur.

• The most common symptoms are non-productive retching and abdominal distension (though a big belly can be hard to identify in some breeds). Dogs may act restless or be lethargic. But nausea— typically evident with salivation and/or disinterest in food—is always severe and unrelenting.

• Bloat is a highly treatable condition, regardless of what you may have heard. In fact, depending on the studies you choose to consume, survival with treatment ranges anywhere from 67 to 85 percent.

• The key to successful treatment seems most unquestionably to lie in rapid identification of the condition. If an animal’s symptoms are identified, rapid transport ensues and treatment is initiated all within an approximately five- to six-hour window, survival rates are significantly higher.

• Large and giant-breed dogs are most definitely predisposed to it. In fact, one study claims that dogs weighing in at 99 pounds or more have a 20 percent risk of bloating at some point in their lives. Another recent study confirms that risk increases with age, and again if siblings or parents have been affected.Nonetheless, we also know that any dog of any parentage and any breed may suffer bloat at any time.

• Dogs who eat rapidly or from raised food bowls seem to suffer an increased risk of bloat (Glickman, et al. JAVMA 2000, 217:10). Feeding from food bowls designed to limit eating speed—commercially available everywhere—and getting rid of that raised feeding stand can help.

• We also understand that bloat is within our capacity to prevent—to a large extent—should we recognize a dog’s risk profile and choose to undertake a relatively simple abdominal procedure called a gastropexy (surgery in which the stomach is “tacked” to the body wall). This procedure is an elective, routine one aimed at preventing bloat from progressing to a critical stage—in advance of an episode. It may not stop the stomach from filling with gas, but it does tend to keep it from twisting. Studies reveal that this approach, undertaken laparoscopically and/or at the same time as another routine abdominal procedure (such as a spay), can definitely help prevent bloat-related mortality.

And here’s where things start to get fuzzy. What about all those feeding recommendations and body conformation studies you may have heard about? If your breed isn’t deep-chested, do you really need to worry? Is feeding twice a day still the done thing? Should you worry about the size of the kibble or your dog’s stress levels? Not all studies come to the same conclusions on all these risk factors for GDV, and some individual researchers have even encountered contradictory evidence on subsequent studies.

Or maybe you have no idea what I’m talking about. In which case, here’s the deal: Bloat in dogs has been researched ad nauseum (pardon the pun), and still we don’t have a reasonable understanding of what leads some to bloat and some to remain GDV–free.

Despite our collective veterinary ignorance, we have identified a few choice predisposing factors that may influence bloat’s onset. Apart from the more concrete findings listed above, veterinary medicine’s bloat risk watchlist currently includes dogs who…

• have a deep chest rather than a “barrel” chest (think Doberman, not Bullmastiff);

• have an aggressive or fearful temperament;

• exercise immediately after feeding;

• are fed only one meal daily;

• get small-sized kibble over the chunkier kind;

• are overly stressed; and

• are especially lean.

However—and this is a big however —these issues have yet to be conclusively proven as GDV risks.

Then there’s the contentious issue of breed predisposition to consider, for which risk assessments invariably list large and giant breeds at the top.While the breeds themselves may vary and disputes arise when it comes to whether X breed beats Y on the bloat-meter, some breeds always seem to prevail: namely, Great Danes, Saint Bernards and Weimaraners.

Knowing all this, it’s now your job to eliminate the predisposing factors you can (feed from the ground and slow down speedy eaters), know what bloat looks like (retching and abdominal distension), treat it like the “mother of all emergencies” it is (get thee to the vet fast), and decline to preemptively “tack” large- and giant-breed dogs at your own risk.

Editor’s Note: Starting in the mid-1990s, Purdue University School of Veterinary Medicine’s Canine Gastric Dilatation-Volvulus Research Program began collecting and studying a range of data; read more about the research and its conclusions at vet.purdue.edu/epi/bloat.htm.

Culture: Reviews
Tell Me Where It Hurts
Broadway, 304 pp., 2008; $22.95
Tell Me Where it Hurts

The first time I read Dr. Nick Trout's book, I curled up in a corner at my local bookstore, chin on my chest with his book in my lap for hours. It was the second time in my life I’d fallen for a veterinary surgeon.

It’s not hard to conclude, then, that what follows will be a largely positive review of Tell Me Where It Hurts. Sure, the subtitle’s a mite contrived, as is the day-in-a-life format Dr.Trout practically apologizes for in his opening bid for his readers’ sympathies. And even if he seems overly eager to make us fall in love with his brand of quirky wit, in the end it’s okay…he’s a surgeon, after all, and even those of the veterinary variety temper their legendary surgical egos with no small dose of charisma.

I mean that as no sly slur, really. All vets love to be loved—present company included. This flaw is part of our innate charm, I think—a forgivably innocuous Achilles heel borne ofmuch client adulation and early success in life. If surgeons offer a bit more bluster than most, well, that’s quite all right—especially if their pomp lives up to its promise.

In his post as veterinary surgeon at Angell Animal Medical Center in Boston, the subject of this memoir, Dr. Trout is uniquely qualified to lead an informative expedition into veterinary medicine’s heart of darkness. After all, his day job is a taxing amalgam of interpersonal skill, medical expertise and technical talent played at the profession’s highest levels.

Instead, Trout trades what might have been a trip down a river of gloomy reality for a veterinary romp in the tradition of the genre’s undisputed genius, James Herriot (of the “All Creatures…” series fame). Exchanging bucolic, 1950s England for 21st-century suburban Boston, UKborn and educated Dr.Trout convincingly recalls everything we ever loved about his countryman, while never letting us forget that this is a thoroughly modern read.

In fact, it would seem that in his urgency to update the master, Dr. Trout manages to raise every notable issue affecting contemporary veterinary medicine—from the feminization of the profession to pet health insurance and the risk of suicide that comes with the territory.Chapter by chapter, he crams it all in, leaving no pet medical stone unturned and no newsworthy animal issue behind.

In the end, Trout relies on his scathing humor and glorious British irreverence to pull out a surprisingly insightful, often hilarious take on himself, his profession, his colleagues, his clients and his patients —in that order. That he does so without raising hackles speaks to his prodigious gift for being downright, self-deprecatingly funny. Yet, in so doing, I can’t help feel his bantering style cuts far from the bone.

But perhaps this more critical opinion is the casualty of a second read. The first go-round breezed by like a busy day at work—one free of responsibilities, as in the voyeuristic, somewhat sadistic pleasure we guiltily succumb to when listening to a smart colleague rant cathartically after a very rough day (preferably over beers at a nearby watering hole).

The second read? I guess I wanted more than a colleague’s easy dissection—some bite, if you will, no matter how droll—if I was going to have a go at the same material again. “Gimme dirt, buddy!” I yelled at the pages (rest assured, in the privacy of my own home this time).

But then, I’m a vet and Dr. Trout’s experiences resonate so well with my worldview of veterinary medicine that I guess I can’t help it if I want a little more Conrad and a little less Herriot in my literature. And, truth be told, I get the vet surgeon spiel every night from the first one I fell for. Thus, I’ve since learned to be critical, even of genius.