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Shea Cox

Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum.

Wellness: Health Care
Christmas in the ER
A different kind of giving and receiving

While many people wake Christmas morning to open gifts and gather with family, we ER types begin and end our day with a slightly different routine. For me, my husband Scott, who is also an emergency veterinarian, and our two Dobie kids, Christmas Day begins with opening presents at 4 am, ends with eating a turkey dinner at 10 pm—with “challengingly good” chaos during the hours in between.  

Working the ER over the holiday is one of those fasten-your-seatbelt types of experiences. Emergency clinics are typically very busy by nature, but over the holidays, the shifts seem to be on steroids.  The normal veterinary world has closed up shop, leaving us to be the first line of care for the patients of nearly 40 area practices. I also think the fact that people are home all day to observe their pets becoming ill or getting into mischief adds to the bustle. Combine these two factors and you have the makings for one action-packed day.

My 8 am shift begins with morning “rounds” and the concurrent consumption of as much coffee as I can down in that hour. Transfer of care of the hospitalized patients then passes to me, and it is not uncommon to have 15 to 20 ailing critters, many of whom require intensive care. I begin by giving each pet his or her morning physical exam (with some added kisses and rubs) and make a continued plan for the day, adjusting medications and ordering up diagnostics as indicated. 

The exams are followed by writing up medical records, interpreting the diagnostics as they are returned to me and making phone calls to the worried owners who have left their pets in our care. Adding to the ride, between the hours of 8 am and noon, I also treat each new patient that walks through our doors. Our skilled nursing staff triages each pet, meaning the most critical are seen first. As you can imagine, it is a constant balance of “who needs it most.”

An amazing phenomenon on this day is that peoples’ patience grows exponentially. Having to wait for sometimes several hours to be seen due to more critical patients becomes a forgiven byproduct of the holiday mayhem, and for this I am grateful. Knowing people have to wait while I treat more critical patients is always a source of anxiety for me. I know worried parents are in the waiting room, equally as worried about their babies. Those are the times when I most wish that I could split myself into many.

Noon is the magic hour for me—the clock strikes 12:00 and another doctor comes on duty allowing me to take a deep breath and play catch up. I swear I see golden rays of light when the swing shift doctor walks through the door, my knight in shining armor—irrespective of gender.

Two o’clock comes around in what feels like a picosecond and with it the tummy starts letting you know you’ve neglected it. After all, a continuous oral infusion of caffeine can only get you so many miles.  And just when I think I’m going to hit the proverbial “E” on my body’s fuel gauge, the ordered-in holiday feast from Andronico’s arrives. I am literally stuffing mouthfuls of stuffing while on the run, but ever grateful to have the calories to catapult me through the second half of the day.

My shift ends at 6 pm, but in ER reality, 9 pm is closer to the mark by the time all the i’s are dotted and the t’s are crossed. Then, coming full circle, I round my patients to the overnight doctor.  In the words of Sonny and Cher, the beat goes on.

As crazy as the ER can be, I wouldn’t change it for the world. I just adjust my seatbelt, according to the peaks of exhilaration and the valleys of exhaustion, because there is no other ride I’d rather be on. It is an indescribable experience knowing that you have forever become a part of some person’s life by saving their beloved family member or by sharing tears when you give the gift of a peaceful death, allowing a pet to pass with quiet dignity in an owner’s arms.

I’d like to share a portion of a card I recently received.  It reinforces why I work these crazy hours, upstream from the rest of the world. It reads:

When you have those days, or weeks or months, when you question what you’re doing in this life, proceed with the questions but please remember the family whose pain and fear you eased and—most of all—the dear dog whose last months you made not only tolerable, but joyful.

Reading this still brings tears to my eyes.

So, at the end of my crazy, draining, exhausting day, I leave with a smile both on my face and in my heart because there is no better feeling than knowing you were the one to make a difference. I love my job, I can’t imagine doing anything else, and being able to help others and their pets on Christmas Day is truly the best gift of all.

 

Wellness: Health Care
Dough Is A Don’t
Risks for dogs include obstruction and alcohol poisoning

My husband has recently taken up the delicious hobby of artisan bread baking. Although this is a pursuit my belly fully supports, it has reminded me of the dangers that raw bread dough poses for our pets. The risks are twofold. The first problem is that dough rapidly rises after ingestion and can cause life-threatening stomach distention and obstruction. The second—and potentially more serious—risk comes from the fermentation of the yeast, which can lead to alcohol poisoning.

Any species can be susceptible, but dogs are most commonly involved due to their often indiscriminate eating habits. Given the opportunity, many dogs will readily ingest bread dough during the process of rising, and because they snarf all that is available, they usually consume 1 to 2 loaves or a pan of rolls. They don’t think, “Hmm, I’ll just save this one loaf for later,” so they generally present with large amounts in their stomachs.

A common scenario is that the soon-to-be bread is placed on a counter to rise overnight, and the next morning the owner wakes to find missing dough and a symptomatic dog. I treated a Labrador for alcohol poisoning just this past weekend after he ate two pizza dough rounds. He stumbled into the hospital with his worried parents but went on to make a full recovery with treatment.

How does it happen?

The warm, moist environment of the stomach serves as an efficient incubator for the replication of yeast within the dough. The expanding dough mass causes distention of the stomach, which compromises blood circulation in the body. The continued distention of the stomach can also make breathing more difficult.

Yeast fermentation also produces ethanol (alcohol) as a byproduct, which is absorbed into the bloodstream, resulting in inebriation and potentially life-threatening disturbances to a pet’s system.

What are the clinical signs?

Early signs can include unproductive attempts at vomiting, visible belly distention and increasing depression. As ethanol intoxication develops, the pet can stagger and become disoriented. Eventually, profound neurological depression, weakness, coma, low body temperature and/or seizures can be seen. Death is usually due to the effects of alcohol rather than from the stomach distention, however, the potential for the dough to trigger life-threatening Gastric Dilatation and Volvulus (GDV or “bloat”) or intestinal obstruction should not be overlooked. [See: Bloat, the Mother of All Emergencies]

How is it diagnosed?

Blood alcohol levels can be obtained through a laboratory, but are generally not used in a veterinary setting; a presumptive diagnosis is usually made based on history of exposure and presenting clinical signs. Other disease processes that can present in a similar way include GDV, other intestinal foreign bodies, ethylene glycol ingestion (antifreeze) and ingestion of antidepressants.

How is it treated?

Vomiting may be induced with recent ingestion in animals not showing clinical signs, although the glutinous nature of bread dough may make removal by this method difficult. In animals where vomiting has been unsuccessful, gastric lavage may be attempted (“flushing” the dog’s stomach with water while he is under anesthesia).

Cold water introduced into the stomach through a stomach tube during lavage may slow the rate of yeast fermentation and aid in removal of the dough. Surgical removal of the dough mass may also be required if a large enough amount has been ingested.

Pets that present with the additional signs of alcohol toxicity first need to be stabilized and have any life-threatening conditions corrected before attempts are made to remove the dough. Alcohol toxicity is managed by correcting metabolic problems, managing heart abnormalities and helping the pet maintain his normal body temperature. Fluid therapy is administered to help enhance elimination of the alcohol from the blood stream. 

Luckily, the dog I treated this past weekend did not require surgery. We supported him with IV fluids and took serial X-rays to monitor the passage of the dough, ensuring no complications developed. Aside from a pizza dough hangover, he made a full recovery in 36 hours.

As always, prevention is the best treatment: If you have a fabulous baker boy (or girl) in your home, be extra conscientious during the rise!

Wellness: Health Care
Holiday Hazards for Pets
Tips for keeping your pet merry this season
O Christmas Tree! O Christmas Tree! You are beautiful, but you can hurt me!

As the holiday season gears up, have you noticed that with the increase in fun and festivities comes a simultaneous increase in the level pet mischief? There just seems to be no way for our curious pups to resist the allure of all that holiday paraphernalia. 

Below is a list (all naughty, no nice!) of the common problems I treat on an emergency basis:

Decorative lights on the tree can pose a serious electrocution hazard when chewed. Signs of electric shock range from a dazed and confused behavior to difficulty breathing, burn injuries in the mouth, seizures and potentially sudden death. Immediate evaluation by a veterinarian is recommended if you suspect electrocution. Take appropriate precautions to ensure lights are hung out of reach and the cord is adequately protected. Use grounded three-prong extension cords and strictly follow manufacturer's guidelines for light usage.

Tinsel and ribbon can potentially cause an obstruction in the intestines when ingested. In medical terms, we refer to these items as “linear foreign bodies,” and they have significant potential to get bound up within the intestinal tract causing a blockage, and in some cases, cutting through the intestines.

Most often, these linear foreign bodies get “hung up” in the intestines, causing deadly “bunching” and can only be removed by surgical means. If you notice a bit of ribbon, tinsel or string, whether from the mouth or the other end (see photo), it is important to remember never cut the ribbon or attempt to remove it yourself! Seek veterinary care immediately.

Vomiting, diarrhea, loss of appetite and depression will be the most common abnormalities seen when an intestinal obstruction is developing, and early surgical care is essential. Exercise extreme caution and never leave pets unattended around string, tinsel and ribbon. 

Ornaments may be ingested and have potential to cause an obstruction leading to the need for surgery. Ornaments made of glass can fall and break, leading to cuts and other injuries. Adequately secure ornaments and place them above the reach of wandering paws and curious noses.

Tree-stand water contains preservatives and sap that may cause vomiting and diarrhea.

Festive plants are often displayed during the holidays and precautions should be taken to avoid ingestion of any plant. Even “nontoxic” plant material, such as pine needles, may cause stomach upset.

Common holiday plants to take particular note of include:

  • Lilies are extremely toxic to cats. Ingestion of any part of the plant, even in small amounts, can cause life-threatening toxicity. Early signs include lethargy and vomiting. Without prompt treatment, most cats will become extremely ill and develop kidney failure within 36 to 48 hours of ingestion.
  • Amaryllis, also known as Belladonna lily, often causes vomiting, diarrhea and belly pain in cats and dogs. It can cause more serous problems including low blood pressure and liver damage.
  • Poinsettia plants are considered to be mildly toxic, often only causing mild stomach upset and/or skin irritation. Treatment is recommended only if any clinical signs develop.
  • Mistletoe and holly species contain a variety of potentially toxic constituents, but serious poisonings are infrequent. Clinical signs are usually limited to salivation, vomiting and diarrhea.

Potpourri is often used around the house to put us in the holiday mood. The plant material and some additives are very irritating to the skin, mouth and intestinal tract. If skin exposure is suspected, then bathing with a mild soap is recommended and medical care may be needed to treat irritation and pain that follow exposure. Ingestion often results in signs that may include drooling, loss of appetite, vomiting, and in some cases, disorientation. 

Treats are a common source of holiday emergencies. While it can be hard to resist your pleading pet’s eyes, it is important to recognize the dangers of particular foods and treats:

  • Fatty foods such as meat trimmings are common culprits for causing stomach upset, vomiting, diarrhea and pancreatitis.
  • Bones expose your pets to many unnecessary risks, including the potential for choking or developing an obstruction in their intestinal tract. Cooked bones when chewed can fragment into small slivers that can cause severe irritation to the intestinal tract as they pass.
  • Rawhides and bully sticks have potential to cause choking and intestinal obstruction.

“People foods” that we take for granted as being safe for us are not always safe for our pets. Raisins and grapes have been implicated in causing kidney failure in dogs. Onion ingestion can cause blood cell damage in both dogs and cats. Chocolate contains caffeine and a caffeine-like substance (theobromine) that dogs and cats are highly sensitive to causing stomach upset, tremors, seizures and irregular heartbeat. Macadamia nuts cause dogs to show a variety of strange neurological signs that can include weakness, apparent pain, disorientation and tremors.  

I hope this information helps you and your four-legged family members avoid any “bah-humbugs” this holiday season!

Wellness: Health Care
Bloat, the Mother of All Emergencies
What you need to know about this life-threatening condition

There is no quicker way to jump to the front of the ER line than if you walk into the hospital with a distended dog. Bloat is a life-threatening condition that I treat frequently, and a good outcome is time-dependent.

Last week, JoAnna Lou wrote about recognizing the signs of bloat and included an educational video of an Akita experiencing GDV (don’t worry, he survived!). This topic elicited excellent comments and questions, prompting me to want to expand upon it further. I hope to answer some of the questions put forth by readers as well as dispel misconceptions that could potentially harm your pet.

First, some vocabulary: Bloat is a condition when the stomach fills with air and/or fluid (dilatation). This can progress to a twisting of the stomach upon itself, called GDV (gastric dilatation volvulus). Bloat is often used to describe GDV, but there is a vast medical difference. We’ll get to the details of GDV in a moment, but let’s start with the most important take-home message:

If you even remotely suspect bloat or GDV, take your dog to a veterinary hospital IMMEDIATELY!

What NOT to do:

  • Do not give anything by mouth.
  • Do not attempt to relieve gas from the stomach with medications or by other means.

A note about the use of Gas X:  This medication may help to reduce the amount of stomach gas in the case of “simple” bloat, but it will do nothing to help your pet in the case of GDV.  The problem with GDV is not the gas, but the actual twisting of the stomach (think of a balloon being twisted in half, like when a clown makes an animal figure). It is the twist that kills, and a medication will not undo the deadly rotation of the stomach. Please do not waste valuable life-saving moments waiting to see if the medication helps! Taking an x-ray of your pet’s abdomen is the only way to tell the difference between bloat and GDV, allowing for appropriate intervention.

What is GDV and why is it so serious?

The twisted and bloated stomach presses on the major blood vessels that carry blood back to the heart, stopping normal circulation and sending the dog into shock. Making matters worse, the stomach tissue is literally dying because it is stretched tightly and blood cannot circulate through it. Intense pain is associated with this disease, causing the heart to race at such a high rate that heart failure will result.

There can be no recovery until the stomach is surgically untwisted and the gas is released. A dog with GDV will die in a matter of hours unless surgery is performed. For each hour that goes by, there is a greater risk for complications during surgery as well as during the recovery period.

What are the signs of GDV or bloat?

  • The biggest clue is the vomiting: A dog with GDV appears highly nauseated and retches but little comes up.

  • Drooling.
  • There is usually an obviously distended stomach, especially near the ribs, but this is not always evident depending on body configuration.
  • Anxiousness, agitation, restlessness and pacing.
  • Depressed attitude.

View some of these symptoms in the video we posted last week.

What dogs are at risk?

Classically, this condition affects deep-chested breeds, and dogs with deep chests that weigh more than 99 pounds have a 20 percent risk of bloat. Although a rare occurrence, I have also treated three small-breed dogs for this condition in my ten-year career.

There are many theories regarding what triggers GDV, but truly, no one really knows—it remains a veterinary medical mystery. Risk factors, lifestyle and personality profiles that may increase a dog’s potential for developing GDV have been identified over the years and include:

  • Feeding only one meal a day.
  • Having closely related family members with a history of GDV.
  • Eating rapidly.
  • Being thin or underweight.
  • Moistening dry foods (particularly if citric acid is listed as a preservative in the dry food).
  • Feeding from an elevated bowl.  
  • Restricting water before and after meals.
  • Feeding a dry diet with animal fat listed in the first four ingredients. (Contrary to popular belief, cereal ingredients such as soy, wheat or corn, in the first four ingredients do not increase the risk.)
  • Fearful or anxious temperament.
  • History of aggression toward people or other dogs.
  • Male dogs are more likely to bloat than females.
  • Older dogs (7–12 years) are the highest risk group.

On the flip side, the following factors may decrease the risk of GDV:

  • Inclusion of canned dog food in the diet.
  • Inclusion of table scraps in the diet.
  • Happy or easygoing temperament.
  • Feeding a dry food containing a calcium-rich meat meal listed in the first four ingredients.
  • Eating two or more meals per day as well as feeding a smaller kibble size.
  • Not breeding animals with a history of GDV in their lineage.

What else can I do?

For breeds with a high risk of bloat, a preventive surgery called prophylactic gastropexy can be performed at the time of spay or neuter. Gastropexy involves surgically “tacking down” the stomach to the inside of the abdomen to prevent rotation. If your dog has already been spayed or neutered, the same procedure can be done laparoscopically, and is minimally invasive. I had this procedure performed on my own Dobie, Bauer. I saw him bloat (and thankfully not twist!) one day at the park, and treated him at work. The next day, I scheduled the laparoscopic procedure.

This is a same-day surgery with a quick and comfortable recovery. In the Bay Area, the cost is generally $1,500–$2,000, which is far cheaper than emergency surgery, and worth its weight in gold for peace of mind. One of my biggest fears was to have Bauer bloat while I was away for the day, only to return home to find I was too late.

It should be noted that gastropexy does not prevent future bloat, but it does prevent future twisting, which is the deadly component of the condition.

What is the prognosis?

Decades ago, a diagnosis of bloat was almost always a death sentence, and only 25 percent of pets with bloat survived. Today, the survival rate is better than 80 percent! Part of the reason for this is increased owner awareness (go, pet parents!) leading to rapid intervention and treatment. The earlier the veterinarian gets started with treatment, the better chance for survival. Extremely aggressive medical and surgical intervention early in the course of the disease has the most dramatic impact on overall success.

This is a condition I see much too frequently, but I have to say from personal experience, nearly all dogs return home (95 percent or greater) with early and appropriate treatment.

Being the doting mom of two Dobies, this is a subject that hits close to home, and one I have experienced personally. Thank you to JoAnna for helping raise awareness of this all-too-common condition in our large-breed babies. Feel free to ask questions; I am happy to further elaborate on any area. For now, I’m off to hug my boy, being especially thankful that he is with me today.

Wellness: Health Care
Watch for Thanksgiving Sneak Attacks
Fatty turkey trimmings can set the stage for pancreatitis

Tomorrow is Thanksgiving, and for many families this means the tradition of spending the day preparing and enjoying a delicious turkey dinner with all of the trimmings. Us humans are not the only ones who look forward to this meal, and I see many dogs in the ER after they have decided to help themselves to a serving or two. While our pets may find this to be an initially satisfying (albeit naughty) indulgence, it can set them up for the development of pancreatitis, a potentially life-threatening disease.

What is the job of the pancreas?

The pancreas is an organ that sits cozily just under the stomach and along the first part of the small intestine. The pancreas is all about secretion and it has two main jobs. The first is the secretion of digestive enzymes to help break down food, and the second is the secretion of insulin and glucagon (to regulate sugar metabolism). The digestive enzymes are the part of the story that concerns us in pancreatitis.

Just what is pancreatitis?

Put simply, pancreatitis is inflammation of the pancreas that disrupts its normal integrity. Digestive enzymes that are normally safely stored are released prematurely, beginning to digest the body itself, and the result can be a metabolic catastrophe. As the tissue becomes further inflamed, the damage begins to involve its next-door neighbor, the liver. Toxins released from this progressive party of tissue destruction can circulate more broadly, causing a body-wide inflammatory response. If the pancreas is severely affected, its ability to produce insulin can be affected and diabetes can result.

The good news is that most commonly the inflammation is confined to the area of the liver and pancreas, and most pets make a full recovery with support.

What causes pancreatitis?

In most cases, we never find out what causes it but we do know some events that trigger it. These can include:

  • Dietary “indiscretion” and ingestion of highly fatty foods (such as eating all the meat, skin and fat trimmings from the turkey!).
  • Obstruction or “back flow” of the pancreatic duct.
  • Hormonal imbalances including diabetes, hypothyroidism and high calcium levels.
  • Use of certain drugs, chemotherapy and the anti-seizure medication potassium bromide. Exposure to organophosphate insecticides has also been implicated. Steroids have traditionally been thought to be involved but this appears not to be true.
  • Trauma to the pancreas (such as a car accident or even surgical manipulation).
  • A tumor or abscess.

Miniature Schnauzers are predisposed to pancreatitis as they commonly have altered fat metabolisms.

Signs of Pancreatitis

The classical signs are appetite loss, vomiting, diarrhea, painful belly, depressed attitude and fever.

Making the Diagnosis

Until recently, a reliable blood test has been lacking. A new newer generation option called the SPEC cPL (specific canine pancreatic lipase) test has come to be the lab test of choice. For dogs only, the SPEC cPL can be run overnight by a reference lab and is able to detect 83 percent of pancreatitis cases and exclude other possible diseases in 98 percent of cases.

This test should not be confused with the “in-hospital” pancreatic test, which resembles a “pregnancy test” and gives you an answer of “abnormal” or “normal.” I am personally not a huge fan of this test because other disease processes (such as liver or gastrointestinal disease) can cause an “abnormal” result.

Ultrasound detects 68 percent of cases and provides the opportunity to look at other organs. Since pancreatitis can be accompanied by a tumor near the pancreas, ultrasound is an important tool for catching such complicating factors. I discuss and recommend this diagnostic for all patients I suspect have pancreatitis.

Treatment

The passage of food through the intestine is a strong stimulus to the pancreas, which is what we want to avoid. Essentially, we want the pancreas to “rest.” This generally means no food or water for 2 to 3 days (in our very ill patients) using IV fluid support to prevent dehydration. Fluid support generally requires electrolyte supplementation and a critical patient will need 24-hour care with blood-test monitoring several times a day. A plasma transfusion represents a specific type of fluid therapy and may be of great help in severe cases.

Pancreatitis can be a very painful condition and pain management is of utmost importance in recovery and is a cornerstone of treatment. Untreated pain affects the immune system and has been shown to increase death rate. Medications to control nausea are also used. Antibiotics are used because even though pancreatitis is not a bacterial disease, bacterial invasion from the diseased intestine is a common occurrence.

Once the patient has started to eat again, a low-fat diet is important to minimize pancreatic stimulation. Since there is potential for the pancreas to always have a smoldering bit of inflammation, long-term use of a low-fat diet is likely to be recommended.

Pancreatitis can be a very severe disease to experience and treat and I hope this helps raise awareness of a potential source of calamity. Please remember to keep your countertops pet-safe: Take all garbage outside promptly and be extra vigilant of the fact that even the most well behaved pets can be tempted with all of the food festivities.

Here’s to a SAFE, happy and wonderful Thanksgiving!

Wellness: Health Care
Keeping Puppy Dog Eyes Clear and Bright
Causes, risks and treatment of cataracts

When you look into your dog’s eyes, what should you see? If your pet is healthy, bright, shiny and clear eyes should be looking back at you. (Well, OK… those three qualities plus a pleading expression, begging for that last bite of whatever it is you are eating.) However, if your dog’s eyes begin to look a little cloudy or bluish-gray, it could indicate that cataracts are forming, which is a sign for you to take him or her to your veterinarian for further evaluation. 

So, just what is a cataract?

Cataracts are characterized by the development of opacity in the lens of the eye. The lens is the normally clear structure that sits directly behind the iris (the colored part of the eye), and its job is to focus light as it moves toward the back part of the eye (the retina). Despite its clarity, the lens is in fact made of tissue fibers. As an animal ages, these fibers become more dense and compact, preventing the passage of light to the retina, leading to blindness.

What causes them to develop?

The most common cause of cataract formation is due to hereditary disease. Other causes include congenital (born with it), senile cataracts (age-related), diabetes, trauma, dietary deficiency (milk replacement formulas that are low in arginine or phenylalanine have been implicated as well as puppies fed strictly evaporated milk formulas or goats milk), electric shock or toxins.

Why is it bad to have a cataract?

A cataract by itself does not necessarily require treatment. If the only problem is blindness, and there is no associated inflammation or glaucoma, it is perfectly reasonable to have a blind pet, as dogs do not depend on vision the way humans do. Blind animals can have an excellent life quality and can adjust well to vision loss (though it is important not to move furniture around or leave any hazardous clutter in the home). Some dogs, however, do become anxious—or even aggressive—when they lose their vision.

Of bigger concern is the fact that a cataract can luxate, meaning it can slip from the tissue strands that hold it in place and end up floating around in the eye, causing damage. Furthermore, if a cataract settles in a place blocking the natural fluid drainage of the eye, a buildup in eye pressure (glaucoma) can result, leading to pain and permanent blindness.

Another problem is the fact that cataracts can begin to liquefy and dissolve after a long time. While this sounds like it should be a good thing, it is a highly inflammatory process, and creates a condition called uveitis. This is a very painful eye disease that can also lead to glaucoma.

How are cataracts treated?

Cataract treatment generally involves surgical removal or physical dissolution (“breaking up”) of the cataract under anesthesia. The ideal time for cataract surgery is the immature or early mature cataract stage.

Obviously, the pet must also be in good general health to undergo treatment. For example, a diabetic dog must be well regulated before cataract surgery. Also, in order for a pet to be a good surgical candidate, he or she must also have a temperament conducive to having eye drops administered at home. Lab work is performed prior to anesthesia and some ophthalmologists also request that pets have their teeth cleaned prior to surgery to minimize sources of infection for the eye.

Historically, removing the cataract meant surgically cutting into the eye and physically removing the lens. (This short video shows a cataract removal—not as daunting as one would think!) This is still done for older patients whose lenses are compact, but for younger patients where the lens is still soft, a technique called phacoemulsification is preferred.

This technique has become the most common method of removing cataracts in dogs. Here, the lens is broken apart by sound waves and sucked out with a gadget similar to a tiny—a few millimeters wide—vacuum cleaner. Artificial lenses are implanted at the time of surgery, restoring essentially normal vision. (Without the artificial lens, the dog’s vision will be approximately 20/800, and objects will appear to be reversed, as in a mirror.)

Cataract surgery is performed routinely with an overall 80 to 90 percent success rate. Long term prognosis following cataract surgery is very good to excellent. Overall, a 95 percent vision rate is reported immediately after cataract surgery, and once cataracts are removed, they cannot return!

What else could it be?

During exams, people often raise the concern that a cataract is developing in their pet’s eye. Generally, the vast majority of the time the pet does not have cataracts, but instead has the much more common condition known as nuclear sclerosis.

Nuclear sclerosis is a normal change that occurs in the lenses of older dogs and it appears as a slight graying of the lens. The older, denser lens begins to appear cloudy. It usually occurs in both eyes at the same time and occurs in most dogs over six years of age. The condition does not significantly affect vision and treatment is not needed.

How your veterinarian can tell the difference between a cataract and nuclear sclerosis is by shining a bright light into the eye. With a cataract, you are unable to see to the back of the eye (the retina); with nuclear sclerosis, you can still see the retina. In the pictures below, you can see how easily nuclear sclerosis (left) might be mistaken for a cataract (right).

If you observe cloudiness in one or both of your dog's eyes, you should bring him or her to see your veterinarian for further evaluation. Your veterinarian can perform a complete physical examination, focusing on the eyes, helping to determine the severity of the problem. Restoring vision for your pet can then be weighed against risk and expense, and it is a personal decision for each family to make.

Wellness: Health Care
Stop that Scooting
The 411 on your dog’s anal glands

No butts about it, anal gland issues are not at the top of anyone’s conversation list. However, it is a fairly common problem that occurs in many of our pets.

Anal sac impaction most often results in only minor irritation (or, shall we say, “rear-itation”), but if left unchecked, an anal sac abscess can develop. This is a common complication that I see in the ER. Owners usually present their pet for “bleeding from the rectum,” when in reality, it is a ruptured anal sac that is draining blood-tinged fluid. It’s what I refer to as “anal sacs gone bad.”

What are they?

Anal sacs are two grape-sized glands just inside of your pet’s anus that contain a foul-smelling material. Prior to domestication, these glands served the purpose of marking an animal’s territory, and could be readily emptied voluntarily. Pets nowadays have largely lost their ability to empty their sacs on demand, and the process occurs naturally during normal defecation when firm feces are passed, lubricating the anal opening in the process. Glands can also “spontaneously empty” during times of stress or excitement; you can recognize this has happened if your dog suddenly develops a very unpleasant odor.

What is the anatomy?

The drawing (below, left) shows the location of normal-appearing anal glands in the dog. The glands lie beneath the surface of this skin and are not something that you can visibly see. The second image (below, right) shows both an inflamed anal gland as well as a ruptured anal gland (more on this below).

How does it happen?

Anal sacs become impacted when a blockage develops in the duct that leads from the gland to the anus. Main causes for the development of a blockage in the duct include having a softer stool or diarrhea, allergies that result in inflammation of the sac and duct, or just plain luck of the genetic draw. Surprisingly, worms are NOT a general cause. (It is a common misconception that a “dog scooting” means that your dog has worms.)

At this stage, the gland is generally swollen and not painful. However, if an infection develops the area can then become painful, swollen and sometimes result in the formation of an abscess. Infection develops because blockage of the duct results in inflammation of those local tissues. In general, when any tissue is inflamed it is no longer happy and healthy, making it easy for the bacteria that normally live in the area to get out of check and “take over,” causing an infection.

How can I tell if my pet’s anal sacs are causing a problem?

One of the first things owners often report is a “scooting” behavior; they observe their pets dragging their bottoms along the floor or carpeting in an attempt to empty the glands. Some dogs will also lick the anal area while others will nip and bite at their bottom or chase their tails.

How is it treated?

I bravely tackled the mission of watching a disturbing array of YouTube videos, trying to find one that best demonstrated the task properly. This video provides a good illustration of the task. It may be considered graphic by some, so please don’t click the link if you are easily queasy—some things are best left to professionals. 

Can I express my pet’s anal glands at home?

Obviously, this is not for everyone, but if you feel comfortable doing so, this is a procedure that can be done at home. It is strongly recommended that you have your veterinarian or groomer demonstrate how to do this for you, for your first time. A second pair of hands up at the front of your dog or cat is helpful to give distracting rubs on the head and praise. A word of caution: Expressing incorrectly can cause irritation and lead to further problems so make sure you are able to perform the task correctly.

What if the scooting continues?

Your veterinarian should recheck the glands if the scooting behavior continues more than a couple of days following sac emptying. If left unattended, an abscess can develop in the gland and rupture through the skin of the rectal region. A ruptured anal sac abscess is oftentimes mistaken for rectal bleeding. Anal sac abscesses are generally treated with antibiotics, pain medications and warm compressing the area at home.

Another important reason to have your pet examined by your veterinarian if scooting continues is that there could also be other causes of this behavior such as allergies, parasites or even referred back pain.

What if my pet suffers from anal sac impaction on a regular basis?

If your pet’s anal sacs need to be emptied every month or more, you may opt to have the sacs surgically (and therefore permanently) removed. The procedure can be complicated as the sacs are located next to many important nerves—mainly those that control rectal sphincter function—and meaning, if improperly performed, your pet could permanently loose control of its bowel function. Despite how scary this sounds, anal sac removal is considered a relatively “simple” surgery by experienced surgeons.

While not the most pleasant of topics to cover, I hope you have found this information informative and helpful!

Wellness: Health Care
The Dope on Pot Dogs
Diagnosis and treatment of marijuana ingestion

Marijuana ingestion is one of the most common toxicities in dogs that I see on an emergency basis, and the post-exam conversation generally starts with the owner asking, "Do you see this often?" I just smile and say, "Well, this is Berkeley..."  

Pets are most frequently exposed to marijuana when they ingest “tasty” baked products, eat the remains of marijuana cigarettes, or get into somebody’s “stash.” Dogs can also get into mischief while out on hikes, finding and eating some abandoned drug.

What is marijuana toxicity?

Marijuana is the dried leaves and flowers from the hemp plant (Cannabis sativa) and the active chemical is tetrahydrocannabinol (THC). THC is absorbed quickly into the bloodstream and signs of intoxication can be seen from within minutes up to 3 hours after exposure. The drug is eliminated quite quickly from the body and most pets will make a full recovery within 24 hours. However, mild clinical signs can last for up to three to four days because the chemical is absorbed into fat.

How is it diagnosed?

THC can be detected in blood or urine but diagnosis is generally based on unmistakable clinical signs as well as history from the owner. The signs are quite textbook, and this is such a common occurrence that our receptionists have learned to pick them out, bringing these pets to the treatment area saying, "looks like we have another pot dog." I myself treat several of these toxicities a month. 

More than 95 percent of the veterinary patients seen for marijuana ingestion are dogs, and almost all exposed animals will exhibit neurological signs. The most common clinical signs we see are incoordination, urine dribbling, drooling, low body temperature and an increased response to stimulation. At higher doses, dogs can suffer from hallucinations with barking or agitation. Seizures, low or high heart rates, respiratory depression and possible progression to a coma can also occur.

How is it treated?

If a pet has recently ingested the marijuana (within 30 minutes) your veterinarian can attempt to induce vomiting to minimize the amount of toxin available to be absorbed. However, if it has been longer than 30 minutes since ingestion, the anti-nausea effects of marijuana usually make it an unsuccessful attempt.

Your veterinarian may also elect to administer activated charcoal, which will help reduce the amount of THC absorbed. Subcutaneous fluids are often given to help prevent dehydration during the recovery period.

If clinical signs are severe, the need for supportive care will be indicated and your pet may need to be hospitalized. Supportive care entails intravenous fluids, repeat administration of activated charcoal, general nursing care, and observation of temperature, heart rate and breathing. If higher doses are ingested, some animals require sedation with valium, and in very rare cases, may require mechanical assistance with breathing if respiration is severely depressed. This is uncommon, but I have personally treated one patient who required ventilator support (he went on to make a full recovery).

Will my pet recover?

Even in extreme cases, the vast majority of animals recover fully and death very rarely occurs.

The main take-away here: Do not withhold information from your veterinarian if you suspect or know that your dog may have ingested marijuana—even if you think that there is no possible way your pet could have gotten into it. Your veterinarian is not under any obligation to report these events, and this information is needed to appropriately treat your pet, as well as avoid unnecessary (and expensive) diagnostic tests.

Wellness: Health Care
Trick or Treat or Trip to the ER?
Keep All-Hallows-Eve safe and fun for pups

Halloween is just around the corner—and as surely as fairies, witches and ghosts will scramble up to front doors, at least a handful of pups will arrive at my ER to be treated for a variety of frightening follies. In an effort to take some of the scare out of your holiday, keep an eye out for these typical trick-or-treat night dangers.

Chocolate

Chocolate, especially dark or baking chocolate, can be very dangerous. The compounds in chocolate that cause toxicity are caffeine and theobromine. The rule of thumb with chocolate is: The darker it is, the more dangerous it is. Depending on the type and amount of chocolate ingested, the symptoms can range from vomiting, increased thirst, belly discomfort and restlessness to severe agitation, muscle tremors, irregular heart rhythm, high body temperature, seizures and death.

Call your veterinarian or local animal emergency if your pet has ingested any chocolate; calculations can be made, based on your pet’s body weight, to determine if it nears a toxic dose that requires treatment.

Xylitol

Candies containing the artificial sweetener xylitol can also cause problems, and even small amounts of it can be highly toxic to your dog. Xylitol is a non-caloric sweetener that is widely used in sugar-free gum, as well as in sugar-free baked products. In people, xylitol does not affect blood sugar levels, but in dogs, ingestion can lead to a rapid and severe drop in blood sugar levels (hypoglycemia).

The hypoglycemic dose for dogs is considered to be approximately 0.1 grams per kilogram of body weight. A typical stick of gum contains 0.3 to 0.4 grams of xylitol, which means that a 10-pound dog could be poisoned by as little as a stick and a half of gum! Dogs may develop disorientation and seizures within 30 minutes of ingesting xylitol-containing products, or signs may be delayed for several hours.

Some dogs who ingest large amounts of xylitol develop liver failure, which can be fatal. The dose to cause liver failure is 1 gram per kilogram of body weight, which is about ten times more than the dose for low blood sugar. A 10-pound dog could go into liver failure if he found and ingested an unopened package of gum, and sadly, this is not such an uncommon occurrence. Any dog who has ingested a xylitol-containing product should be examined by a veterinarian immediately!

Decorative pumpkins and corn

Decorative pumpkins are considered to be relatively nontoxic, but they can produce stomach upset in pets who nibble on them. Decorative corn is of a higher concern as the cobs can pose a risk for obstruction in the intestines if ingested. Luckily, corncob pieces can be seen on radiographs, making the diagnosis of an accidental ingestion relatively easy.

Costumes

Even though our dogs can look smashing in a pumpkin or pirate costume, many pets can have adverse reactions to a constrictive outfit or its irritating materials.

If your pet is a real ham and loves to partake in the festivities, make sure the costume isn't annoying or unsafe by scheduling a dress rehearsal well before the big night. Take a close look at your pet’s costume and make sure it does not have small, dangling or easily chewed-off pieces that they could choke on. Also, ill-fitting outfits can get twisted on external objects, or your pet, leading to injury. It should not constrict your dog’s movement or hearing, or impede its ability to breathe or bark. 

Does your pet have sensitive skin? Even those with hearty coats can have allergic reactions to the synthetic materials found in many costumes. If your pet seems distressed, allergic or shows any abnormal behavior, consider letting them go au naturale in his or her birthday suit or donning a festive bandana.

Door dangers!

During trick-or-treating hours, it is best to keep pets in a room away from all the excitement at the front door during peak hours, as too many strangers can be scary and stressful for pets. When opening the door for trick-or-treaters, take care that your pup doesn’t dart outside.

Always make sure your dog has proper identification. If your pet escapes and becomes lost, a collar and tags and/or a microchip can be a lifesaver, increasing the chances that he or she will be returned to you. Please ensure that your pet’s microchip truly has been registered, and just as important, that your address and phone numbers are current!

Sadly, many animals that have been microchipped are not actually registered in the system and we are sometimes unable to reunite families. If you are in question as to whether your pet’s microchip is active and properly registered, you can see your veterinarian or stop by PETS Referral Center if you’re in the Berkeley area to have your pet scanned at no cost—we are open 24/7 365 days a year.

Keeping pets safe on Halloween shouldn’t be a scary endeavor, and I hope this blog has helped prepare you for the upcoming Halloween night!  Boo!

 

Wellness: Health Care
Tetanus: Not Just from Bites and Rusty Nails
Foxtails are another source of the toxin
Dog Yawning

We have all heard of tetanus shots and have some sense that we are supposed to periodically get them, especially after a dirty cut, scratch with a piece of metal or some sort of bite wound. Some of us may even know that tetanus is often referred to as lockjaw, but the general knowledge of tetanus generally does not extend much beyond that, and many people are not aware that tetanus can be a problem for animals as well as people.

Different animal species have different sensitivity to the tetanus toxin. On the spectrum of tetanus sensitivity, horses, humans and livestock are most sensitive and dogs are less sensitive. And then there are cats: They are quite resistant and almost never get infected (as we all know, cats have a different rule book than the rest of us). We will, of course, focus on our favorite, dogs.

How does exposure occur?

Tetanus is a disease caused by a toxin that is secreted by a bacterium known as Clostridium tetani. These bacteria are anaerobic, meaning that they grow in conditions where there is no oxygen, such as a deep bite wound or puncture. Clostridia are soil bacteria and they live in dirt, so it is easy to see how a puncture contaminated with dirt would be the classical tetanus-yielding wound. Such wounds are particularly common on farms where there might be nails on the ground, ready to pierce a pet in the foot. A fight involving a bite wound and rolling around in dirt might also offer an opportunity for tetanus.

Another interesting source of exposure are foxtails. A study performed at UC Davis School of Veterinary Medicine looked at 35 cases of canine tetanus and found the initial wound for 27 percent of the dogs treated was a foxtail tract, and an additional 50 percent of wounds were suspicious of foxtail tract! An important take away of this study: The wound does not need to be a bite or traumatic puncture. Yet one more reason to fear the foxtail! [See Protecting Your Dog Against Foxtails by Nancy Kay, DVM.]

What is the toxin and how does it work?

The tetanus toxin is called tetanospasmin and it is produced by the bacterium Clostridium tetani in a wound. Here comes the nerdy part: The toxin binds to local nerves and moves up into the central nervous system where it interferes with the release of glycine, an amino acid that also acts as an inhibitory neurotransmitter. The result of this loss of inhibition is painful muscle over-activity, spasms and rigidity. In severe cases, the pet cannot breathe because of the rigid paralysis of the respiratory muscles and a mechanical ventilator is required.

Initial signs seem to pertain to the eyes and can easily be mistaken for eye disease in the early stages. Classically, the pet loses the ability to blink and must flash the third eyelid to moisten the eye. The patient becomes so sensitive to light and sound that clapping your hands can create spasms or seizures. In this phase of disease, these signs may be attributed to other toxins, such as snail bait or moldy toxins, resulting in a misdiagnosis.

Dogs with ears that hang down may develop ears that stand up straight, and the facial muscles pull back in such a way as to create what is called risus sardonicus, or the sardonic grin. In more advanced stages, the patient can no longer walk and will stand stiffly in what is called a sawhorse stance.

This video on tetanus shows the characteristics symptoms (don’t worry, happy ending!).

How is this diagnosed?

Unfortunately, there is not an easy diagnostic test that can be performed to give us the “ah-ha!” answer. The diagnosis is generally made based on the appearance of the pet and history of a wound. Classically, there is a history of a wound in a tetanus case (generally in the preceding 1 to 2 weeks) but sometimes the wound has gone unnoticed by the owner and this important clue is not available.

It is possible to measure antibody levels against the tetanus toxin, but this has not been widely used in the clinical setting. Also, attempting to culture Clostridium tetani from the wound, as a way to support a diagnosis, is generally not successful.

How is it treated?

The first step in treatment is antibiotics to kill the Clostridia. Happily, exotic antibiotics are not needed: Good ol’ fashioned penicillin does the trick. Sedation and anti-seizure medications are necessary to control the muscle spasms and/or seizures. Nursing care is a cornerstone of treatment and requires a darkened room with minimal stimulation.

Clenched jaws can be problematic for feeding, and a liquid diet or slurry is needed. Soft bedding to prevent bedsores is a must. The decision on whether or not to include tetanus antitoxin is more controversial. Antitoxin is an antibody solution (a blood product) generated by either a horse or human to bind and destroy the tetanus toxin.

Improvement is generally noted within the first week of therapy but complete recovery can easily take a month.

What about a tetanus shot?

Tetanus toxoid is the tetanus shot most of us have had at one time or another. It is a vaccine against the tetanus toxin and it is part of our own human vaccination set. Because dogs are much more resistant to tetanus than humans, regular vaccination against tetanus is not recommended for them.

I’ll end this topic by saying that luckily this is not a common occurrence; I have only witnessed one case of this in my 10 years of practice. However, the potential does exist and it is always good to have this kind of knowledge sitting on the back burners of our brains… you never know what kind of medical mischief our pets will get in to!

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