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Wellness: Health Care
Investigating Halitosis
Bad breath may not be a sign of dental disease

Halitosis is the fancy word for bad breath, and that odor is nearly always a sign of a bigger problem. Just this week, I noted a slightly foul odor coming from my own little girl, Dharma. On closer inspection, I noted that the very top of her canine tooth is beginning to turn brown. Overall, the tooth and gumline appear pretty much normal, but I am suspicious of a tooth root infection lurking below.

As in Dharma’s case, the cause of halitosis is most often attributed to dental disease, but there are many other sources of odor that should be considered and put on your mental checklist. These can include:

Metabolic causes:

  • Diabetes.
  • Uremia: This develops with kidney failure, when the body cannot clear urea and nitrogen waste products from the blood.

Respiratory causes:

  • Inflammation of the sinuses or nasal passages.
  • Cancer/tumors.
  • Foreign objects up the nose, such as a piece of stick, food or even a lodged foxtail.

Dermatologic causes:

  • Infection of the skin folds around the lips, known as lip-fold pyoderma.

Dietary causes:

  • Eating offensive smelling food.
  • Eating other odorous substances, such as feces.

Diseases of the mouth, in addition infection of gums and teeth, your “basic” dental disease:

  • Ulceration of the tissues of the mouth, which can happen with kidney disease or other trauma.
  • Inflammation of the throat or tonsils.
  • Cancer/tumors.
  • Foreign objects.

Trauma causes:

  • Electric-cord injuries, such as biting a live wire.
  • Fractures.
  • Exposure to caustic agents, such as Tide detergent (Hard to believe a dog would eat that, but I’ve seen it).

Infectious causes:

  • Bacterial, fungal, viral.

Miscellaneous causes:

  • Autoimmune causes: A condition where the body can attack itself because it “sees” its own tissues as foreign.
  • Diseases caused by masses in the mouth containing a type of white blood cell known as an eosinophil or eosinophilic granuloma complex.

Halitosis is a diagnosis that is easily made: Just smelling your dog’s breath at home is the first step. If there is a disagreeable odor, halitosis is present, and there’s a problem. As the list above illustrates, a full spectrum of potential sources of “yuck mouth” exist, and interestingly, as varied as these potential causes can be, sometimes the first clinical sign observed in many of them is odor.

If the diagnosis is not obvious from a peek in the mouth (such as a bad tooth), further steps will be needed check for other disease. Once the reason of the bad breath is discovered, therapy can then be directed at correcting the cause.

The major take-away message is that halitosis is not a disease in of itself, but a sign of disease. While bad breath generally indicates an unhealthy mouth, there are many other potential causes to consider, and evaluation of this symptom by your veterinarian is recommended.

Wellness: Health Care
Melamine: Toxicity in Dog Food
Recall Follow-up
Marion Nestle

For the last year or so, we have been working on a book about pet food, What Pets Eat, to be published by Harcourt late in 2009. One of the pleasures of a long-term project like this is the time to follow digressions wherever they lead. Last year’s (2007) massive pet food recall was so much of a diversion that it resulted in a spin-off publication—Pet Food Politics:Chihuahua in the Coal Mine —scheduled for release this September by University of California Press.

The recall made us especially curious about the role of melamine, the substance responsible for kidney failure in pets eating food that supposedly contained wheat gluten. Just a glance at the chemical structure of melamine shows that it is high in nitrogen, a nutrient usually obtained from protein. This made us suspect that melamine must have been added deliberately to boost the apparent amount of protein in wheat gluten, because methods that measure the amount of protein in animal feed count nitrogen, not protein itself. Our suspicions were confirmed. The toxic “wheat gluten” turned out to be wheat flour laced with melamine.

But why would melamine harm cats and dogs? A quick search for studies of melamine toxicity turned up several performed on rats and mice, but just one on dogs (which dated from 1945).These studies gave the impression that melamine was not very toxic except at extremely high doses. Furthermore, the kidneys of animals who had eaten the contaminated food contained odd crystals that did not look like crystals of melamine.These turned out to be formed from complexes of melamine and one of its by-products, cyanuric acid. Even so, researchers and federal officials were puzzled. They had not heard of associations of melamine or cyanuric acid with kidney failure.

Really? Our Internet search turned up a brief and not particularly informative abstract of a 1960s study on melamine toxicity in sheep.We thought we needed to look at the entire paper, and found it and others in old bound journals in the Cornell library. These decades-old studies demonstrated that melamine is quite toxic, and causes kidney-related symptoms in animals at doses nearly identical to those reported in contaminated pet food. The studies were designed to test the idea that, because melamine nitrogen is far less expensive than protein nitrogen, melamine might have two useful purposes: (1) as an honest feed additive for ruminant animals, whose microorganisms can convert nonprotein nitrogen to amino acids, and (2) as a dishonest adulterant that makes feed test as though it contains more protein than it really does.

By following other leads,we also found references to relevant studies from the early 1980s in Italian journals that we had to request through interlibrary loan. These showed that melamine was so frequently used for fraudulent purposes in the 1980s that Italian scientists developed a test for it. They used the test to show that melaminna had been used to adulterate more than half the samples of fish meal they examined.

Most of the early information about melamine toxicity came from attempts to use it as a drug or nutrient. In the 1940s, investigators explored its potential as a canine diuretic. To follow what comes next, pay attention to the size of the melamine dose in milligrams per kilogram (mg/kg) of body weight, and recall that a kilogram is 2.2 pounds. The 1945 study showed that at a dose of about 120 mg/kg, dogs excreted crystals in their urine but otherwise did fine. In the 1960s, investigators used cyanuric acid (which is 32 percent nitrogen) to feed ruminant animals, and observed no problems even at high doses.Wouldn’t melamine (66.6 percent nitrogen) work even better?

A South African scientist fed daily doses of about 250 mg/kg to sheep, but most animals refused food and lost weight, and some of them died. Another South African investigator gave melamine doses to a single sheep, starting with 2,600 mg/kg. At such high doses, the sheep died within a few days from kidney damage, and the investigators could see crystals of melamine hanging from the animal’s prepuce. Lower doses of melamine caused sheep to stop eating, especially if their water intake was restricted. These studies suggested that a dose of about 250 mg/kg kills some— but not all—sheep over time.So, by 1968, melamine was known to induce kidney damage when fed to sheep over prolonged periods. Ten years later, American investigators tested melamine in cattle and found that a dose of about 100 mg/kg caused four out of six steers to refuse feed.

We think these studies are highly relevant to the pet food situation. The FDA reported that melamine could have accounted for 10 percent of the weight of the false wheat gluten, and the false wheat gluten could have accounted for as much as 10 percent of the weight of the pet food. If so, 100 grams—about 3 ounces—of pet food could have contained as much as a gram (1,000 milligrams) of melamine, and an average cat or small dog could have eaten an amount close to the 250 mg/kg level that proved toxic to sheep in the 1960s.

Recently, investigators from Georgia and the University of California, Davis, have shown that much smaller amounts of melamine can form crystals if cyanuric acid is also present. In cats, doses as low as 32 mg/kg each of melamine and cyanuric acid caused crystallization and kidney blockage.

We were surprised that neither the university or FDA veterinarians involved in the melamine investigations knew about this earlier work, but we think we can guess why. Papers in international journals are not readily accessible on the Internet, and the old animal feed literature is not likely to be studied these days.We had to discover the papers the old-fashioned way, by going to the library in person, sifting through reference lists, following up leads that sometimes required interlibrary loans and pursuing the reference trail back to its origins.We had the interest and time to pursue these questions. For the veterinarians and FDA officials caught up in the heat of the recall, a trip to the library might have seemed like a luxury they could ill afford.

We can’t say whether earlier suspicion of melamine would have hastened the recall or improved veterinary care of the sick dogs and cats.But we can say that the old experiments on animal feeding are well worth reading, that it’s best to read entire papers and not just their abstracts, and that libraries still have much to offer that the Internet cannot.

This article is based on Nestle M., Nesheim M.C. Additional information on melamine in pet food [letter]. JAMVA 231(2007):1647.

Wellness: Health Care
Can Your Dog Give the Gift of Life?
The importance of canine blood donors

Not long ago an adorable Dachshund-mix puppy named Sunny was brought into my ER because he was having trouble breathing and was coughing up blood. A quick blood test determined that he had eaten rat poison. A blood transfusion was required to save his life. He made a full recovery.

The need for blood or plasma transfusions is a frequent occurrence in our referral hospital, and can be crucial in many situations including trauma, immune diseases, blood-loss during surgery or, as in the case of Sunny, for eating rat bait.

When a lifesaving transfusion is recommended, the natural question by worried pet parents is, “Where do you get this from?” People are generally surprised when I answer, that just like for us people, there are canine blood banks.

Canine blood banks
Veterinary blood banks are a fairly new concept, developed during the past 10 to 20 years, and there are essentially two kinds: collection centers using volunteer dogs and centers that house and care for their own group of donor dogs who live on the grounds of the blood bank.

Community-based donor programs rely on volunteers to bring in their pets for blood donation. There are several veterinary schools that participate in this kind of program, including University of California, Davis, School of Veterinary Medicine. Incentives to volunteers can include free annual health exams and blood work, heartworm prevention and food. Some programs even offer a return gift of blood at no cost if the donor ever needs it during his or her lifetime.

Animal Blood Resources is an example of the second type of blood bank. It obtains donors through partnerships with rescue groups, providing a working solution for unwanted adult dogs and cats.

These donors are given a temporary home where they can frolic and play, including getting trained for agility! Additionally, there is a force of volunteers who groom, cuddle, walk and play with them. After one year of providing their lifesaving service, every animal is adopted into a permanent home in great health and well socialized.

Could your dog donate?
Donor dogs must be between one- to six-years-old, weigh at least 55 pounds and be free of any medications. Prior to becoming a donor, all dogs are screened for infectious diseases and are given a full veterinary exam to ensure that only healthy dogs enter a donation program.

Next, their blood type is determined. Dogs have six major (but up to 13 different) blood types. The preferred donor is antigen 1.1 negative. In the dog world, they are considered “universal donors” and are similar to type-O universal human donors.

Donor dogs can “roll up their fur sleeves” every 2 to 3 months, but this varies by blood bank. Sedation is not needed—just plenty of head rubs and treats. The blood draw takes about 10 minutes.

A single donation can be used to save up to four lives, because the blood can be separated into two components, red blood cells and plasma.

People understand how important it is to donate blood, and the same holds true for our pets. In the case of canine donations, one dog can give the gift of life to many others. One more reason to add to my list of why dogs are my heroes.

Interested in having your dog become a donor or adopting a retired donor? If you live in California, contact the University of California, Davis, Veterinary Medical Teaching Hospital at (530) 752-1393. Or ask your veterinarian or local shelter.

News: Guest Posts
Crufts Show Dogs Disqualified
Canine controversy erupts into blame game
Crufts 2012 best in show Lhasa Apso

England’s most prestigious dog show, Crufts, is now also its most controversial. This past weekend,  several Best of Breed winners were disqualified after health inspections by an independent veterinary surgeon. Of 15 so-called “high profile” breeds (out of more than 200 breeds entered) required to undergo a veterinary exam, six breed winners  failed: the Basset Hound, Bulldog, Clumber Spaniel,  Mastiff, Neapolitan Mastiff and Pekinese. Thus ended their chances of going on to win Best in Show, the highest achievement at Crufts.

Dog fanciers around the world are in an uproar, claiming that animal rights activists and Jemima Harrison’s 2008 BBC documentary, “Pedigreed Dogs Exposed,” are infringing on their right to breed and show. 

Best in Show Daily blogger and longtime fancier Billy Wheeler wrote, in part: “Now here is the real rub. It is the vet, who may or may not have ever bred a litter in his/her life, who makes the determination as to whether the Breed winner is worthy of the award, not the judge. I’ll hold to a future post the discussion of how veterinary students are being brainwashed today, but many of you have already run across vets who are not sympathetic to our hobby.”

Honest Dog blogger Gina Spadafori—who has long lamented the prevalence of cancer that prematurely kills her favorite breed, the Flat-Coated Retriever—says it’s about time. In response to Wheeler’s above comments, she writes, “… I have attended seminars at two separate world-class veterinary conferences where boarded veterinary surgeons and internists said that these extreme structural malformations you so prize has led to dogs whose respiratory systems are so compromised that the animals need to have corrective surgery in adolescence. That’s so they can live a normal life—or in too many cases, just live to middle age.
 

“ … those veterinarians who ‘may or may not have ever bred a litter’ have sure as hell delivered your litters by C-section, because that’s how Bulldogs come into this world, their heads being too large to be delivered normally. If breeding for these traits isn’t animal cruelty, it’s hard to imagine what is.”

Some criticize the Kennel Club for singling out 15 breeds for the veterinary exams, claiming it would be more fair—and effective over the long term—for all entrants to undergo the health check. Others think it’s a step in the right direction and the process will evolve as needed.
 

Do you think the AKC should follow suit with Westminster? Why or why not?  

Wellness: Health Care
“Pot Patch” for Pups
Company explores pain-relief potential for pets

Last year, a company called Medical Marijuana Delivery Systems, LLC (MMDS) acquired the rights to a patent for a transcutaneous (through the skin) delivery of medical marijuana to humans and animals. Since our pets suffer from many of the same debilitating illnesses that we do, and with many states legalizing the use of medical marijuana, it doesn’t seem like such a stretch to apply this concept of care to our pets. This “pot patch for pups” has been given the trade name Tetracan, and the goal is for public availability by the end of 2012.

 

At first blush, the thought of canine cannabis sounded a bit over the top to me. However, current research shows this new marijuana patch is a very reliable delivery system. The maker of this product ensures that only the pain relieving effects are transmitted to the patient and that it will not make your pet “high.” (See my earlier blog post about dogs brought into the ER after eating marijuana.)

 

This transcutaneous patch is being developed to help patients manage pain, nausea and anxiety but without the psychotropic effect of marijuana. Seattle-based MMDS is also working on topical applications for animals in place of the patch; it would be similar to applying the monthly flea and tick treatment with which many pet parents are familiar.

 

Of course, to buy the patches or ointment, you’d need to be a medical marijuana patient yourself since dogs can’t get authorization from a veterinarian. That is, at least, not yet. The company is pressing for changes in state laws to permit veterinarians to prescribe medical cannabis for pets.

 

What does the American Veterinary Medical Association think of Tetracan? At this time, the association has not released a position statement on the use of medical marijuana on animals, but it has done extensive studies on the use of fentanyl patches for pain relief. Dispensing fentanyl, a highly controlled substance and potent synthetic narcotic, is well within normal veterinary practice standards.

 

Fentanyl is 100 times more potent than morphine and needs to be used cautiously in geriatric, very ill or debilitated pets, especially those with underlying respiratory issues. This leads the medical devil’s advocate to ask, “Why not try to integrate a more natural, plant-based approach?” Harnessing the pain relieving effects of marijuana may prove to be a safer alternative for these pets.

 

While the patch does conjure up visions of pups frolicking in fields of poppies and wanting extra helpings of kibble, I have to say that I can see several potential benefits if it is carefully researched and brought to market. It will be interesting to see how the medical and legal aspects of its use develop. It may prove to be a potential alternative to chronic pain in our pets, especially when some chemical pharmaceutical painkillers can be harmful, sometimes even fatal, in weakened pets.

 

► What do you think about medical marijuana for pets? If it were deemed safe for dogs, and was recommended by your veterinarian, would you consider using a marijuana patch on your dog?

Dog's Life: Lifestyle
Helping Injured Pups Walk
Experimental drug could help dogs and humans with spiral cord injuries

I love when medical research benefits both canines and humans. This latest study aims to help dogs and people retain their ability to walk with a new medication.

The U.S. Department of Defense is funding research to explore an experimental drug that will help dogs and humans with spinal cord injuries. The collaboration between the University of California, San Francisco (UCSF) and Texas A&M has already proved that the drug mitigates spinal cord damage in mice. The next step will be to see how the medication works in dogs. The study will specifically be looking at short-legged, long-torso breeds like Dachshunds, Beagles and Corgis. It's not uncommon for these breeds to spontaneously rupture a disc, damaging the spinal cord.

Most spinal cord injuries lead to chemical reactions that damage nearby cells and pathways, contributing to decreased hind limb function. The experimental drug may help stop this process and help dogs preserve the use of their legs.

Canine spinal cord injuries are similar to human spinal cord injuries, so scientists are hopeful that the research can help both dogs and people. A win-win for everyone!

Wellness: Health Care
Detailing the Dangers of Chicken Jerky. UPDATE.
Update on toxic treats from China

[Update, 3/9/12: The FDA has released new product safety information about chicken jerky treats from China. Update, 3/14: The FDA has just released the TOP 3 brands cited in chicken jerky poisoning cases: Waggin’ Train (Nestle Purina); Canyon Creek Ranch (Nestle Purina); Milo’s Kitchen Home-style Dog Treats (Del Monte)]

China has been in the news repeatedly for problems related to the production of chicken jerky treats thought to be responsible for illness and death in our canine companions.

The connection between China and toxic pet food and treats first surfaced in 2006, when melamine-contaminated food additives imported from China triggered a nationwide recall of dog food items from a variety of manufacturers. The illness and deaths of thousands of dogs and cats were linked to the melamine.

In 2010, problems returned with 50 reports of a Fanconi-like syndrome (more on that in a second), thought to be linked to the ingestion of chicken jerky treats from China, with this number increasing to more than 70 reports in 2011.

In November 2011, the Food and Drug Administration (FDA) finally issued an official warning to pet owners that chicken jerky food products imported from China may cause a Fanconi-like syndrome in dogs who routinely consume them or in cases where treats make up a large part of a dog’s diet.

Just last week, the FDA announced it is now analyzing products upon import for both melamine and diethylene glycol (another suspected toxin) because of an increase in pet owner complaints. Ready for the numbers? There have been 467 reports concerning toxicity placed with the FDA since it issued the official public warning in November 2011!

Just what is “Fanconi-like” syndrome?

This uncommon condition affects kidneys, causing them to leak glucose (sugar) and other electrolytes into the urine. Dogs who have this condition will usually be very thirsty and urinate excessive amounts. The most common finding in laboratory tests is that the dog has glucose in the urine, but has a normal blood glucose level. Symptoms of this illness include drinking a lot of water, urinating a lot or more frequently, decreased energy, diminished appetite, diarrhea and vomiting.

The spectrum of illness and recovery is broad. Some dogs go into renal failure and die while others will have only an increase in thirst and urination and go on to recover fully within a few weeks of stopping the chicken jerky treats.

Until more is known, these are the specific recommendations made by the FDA:

  • Chicken jerky products are not intended to be substituted for a balanced diet and should only be fed only in small quantities.
  • Consumers who feed chicken jerky products to their dogs should monitor for symptoms of decreased energy, decreased appetite, vomiting, diarrhea, increased water consumption and increased urination.
  • Discontinue the products at the first occurrence of such problems.
  • Seek immediate veterinary care if symptoms are severe or persist for more than 24 hours.

My recommendations are a little more straightforward:

  • Buy American treats or, better yet, bake your own or buy locally made ones!
  • Raw or cooked vegetables also make tasty alternatives, and are especially good for pups who need to lose weight.

What should I do if I suspect my pet has been affected?

Have your veterinarian examine your dog and perform blood and urine tests. These tests will help determine if the Fanconi-like syndrome is present, or if your pet has other possible medical issues such as Cushing’s disease, diabetes or kidney disease.

You should report cases of illness associated with pet foods to the FDA Consumer Complaint Coordinator in your state, or you can go to the following website for further instruction on how to report a pet food complaint: http://www.fda.gov/petfoodcomplaints.

Where next?

Frustratingly, there has yet to be a specific causal link or contaminant identified. To date, scientists have not been able to determine a definitive cause for the reported illnesses (hence, no recall yet), but they do continue to perform extensive chemical and microbial testing on products.

Politician and pug parent U.S. Senator Sherrod Brown of Ohio has become the latest unofficial champion for pooches all across America. The sympathetic senator took to the Senate floor the first week in February and urged swift action on the part of the FDA to step up their investigation.

Lets hope others follow in his footsteps, and in the meantime, let’s keep spreading the word about keeping imported treats out our pet pantries.

Wellness: Health Care
Swallowing a Penny Comes at a High Price for Dogs
Common cents caution for pets

Humans aren’t the only species with money troubles. Did you know that pennies can be hazardous to your dog’s health? One-cent coins used to be made from 100 percent copper, which is nontoxic. In 1982, the government began minting pennies that were made mainly from zinc (much cheaper) and coated them with a thin layer of copper, keeping the look of a penny. When swallowed, the copper coating of the newer penny dissolves in the stomach acids, leaving a wafer of toxic zinc.

A few years back I saw a dog who had been vomiting for two days and his blood work revealed both anemia (low red blood-cell count) and elevated kidney values. There are many causes for this type of presentation, including infectious disease, immune-mediated disease, inflammatory disease and toxins, just to name a few.

His owner had no idea if he’d eaten anything out of the ordinary. X-rays revealed a round metallic object in the stomach. You guessed it, a penny. The penny was removed non-surgically with an endoscope, and the dog recovered during the course of the week with intensive supportive care—a very expensive penny.

The clinical signs and potential problems caused by zinc toxicity include:

  • vomiting and diarrhea,
  • blood-tinged urine,
  • icterus (yellow mucous membranes including gums and the “whites” of the eyes),
  • liver failure,
  • kidney failure,
  • hemolysis, which is the destruction of red blood cells (how zinc produces hemolysis is not known),
  • anemia.

Treatment:

If an object possibly made of zinc is seen on a radiograph, it should be removed promptly. Supportive care then becomes crucial and includes fluid therapy to keep circulation to the kidneys adequate, helping to prevent failure. A blood transfusion may be necessary to combat anemia. Anti-nausea medications are indicated, as well as stomach protectants (antacids and “coating” medications), due to the corrosive nature of zinc. Researchers are still actively looking at methods for binding excess zinc in the circulation, similar to the way lead poisoning is treated, but this is not yet available.

Other sources:

Other sources of zinc include hardware, such as nuts and bolts, dietary supplements, and (surprisingly) zinc oxide–based skin creams, such as diaper rash ointment and sunscreen.

Prevention of zinc toxicity:

  • In addition to coins, be mindful of the nuts and bolts on your dogs’ kennels, as they may contain zinc.
  • Do not use ointments and creams on the fur or skin of your pet, unless directed by your veterinarian, as these usually get licked off, potentially causing toxicity.
  • Keep vitamins, dietary supplements and topical creams far out of your pets reach.

Many people are unaware of this syndrome and do not realize that pennies are far more dangerous than a “simple” foreign body. This is a recently described disease process and many questions are still unanswered. As always, prevention is best: ”Penny wise, pound foolish” has a whole new meaning.

Wellness: Health Care
When Diarrhea Turns Dangerous
Understanding hemorrhagic gastroenteritis
After four days of intensive care, this HGE-sufferer dog named Sam made a full recovery.

One of the more common problems I see on an emergency basis is a disease process called hemorrhagic gastroenteritis, also known as HGE. I recently treated Sam, the little Beagle in the photo, for a severe case of this disease.

The history I hear from owners is always the same: “My dog started having diarrhea and then, all of a sudden, it became very watery and bloody.” This can be horrifying to first-time observers and usually prompts a trip to the ER.

Hemorrhagic gastroenteritis is a potentially life-threatening intestinal condition, which manifests as a sudden onset of bloody, watery diarrhea, with vomiting often being part of the syndrome. Sloughing of the lining of the intestines occurs from severe inflammation leading to “chunks” of tissue in the otherwise watery stool. We describe this as “raspberry jam” diarrhea. This process is extremely dehydrating—much more than you would think from the amount of diarrhea observed—and dogs can go from “near normal” to “near death“ in a frighteningly short time. If HGE is not promptly treated, the massive loss of fluid can cause life-threatening shock.

Smaller dogs seem to have a predisposition towards HGE, and it should be noted that the smaller the dog, the more dangerous the condition. Small dogs just don’t have the same bodily reserve as a larger dog; it simply doesn’t take much for them to become severely dehydrated. 

Thankfully, there are no long-lasting bodily effects of HGE, however, some dogs that have sensitive GI tracts to begin with can have the syndrome recur in the future.

What causes HGE?

Stress, sudden dietary changes and hyperactivity seem to be predisposing factors, but the actual cause remains unknown. A bacterium called Clostridium is also thought to play a role. In short, the condition is truly another medical mystery, and I can relate to an owner’s confusion and frustration when they ask, “Yeah, but what actually caused it?” I cannot point to an exact cause in more than 80 percent of HGE cases I treat.

How is this condition diagnosed?

There are no specific tests for HGE but a test called a packed cell volume (PCV) is helpful in narrowing down the diagnosis. Using a few drops of blood, the test measures the percentage of blood volume made up by the red blood cells. A normal packed cell volume for a healthy dog is between 37 and 55 percent, meaning that 37 to 55 percent of the blood volume should be red blood cells (the rest of the volume is fluid and white blood cells).

When the patient becomes very dehydrated, there is less fluid in the bloodstream and the percentage of blood fluid drops, and consequently the percentage of red blood cells increases. A dog with HGE will generally have a PCV greater than 60 percent.

The measurement of the PCV also includes a measurement of total protein (sometimes called total solids). In HGE, the total protein measurement from the blood sample is low or normal.

A very high PCV, low total protein and acute onset bloody, watery diarrhea can point to a diagnosis of HGE.

From a medical standpoint, one of the things that makes diarrhea difficult is that no matter what the underlying cause, the clinical picture looks exactly the same. Because of this, we may still recommend that additional tests, such as radiographs, a fecal exam (that includes a parvovirus test) and blood work, be performed to make sure there is not a more serious problem causing the clinical signs.

HGE really becomes a diagnosis of exclusion: When blood work, radiographs and fecal exams are normal, we highly suspect HGE as the cause.

What is the treatment for HGE?

The heart of therapy is very aggressive fluid replacement with intravenous fluids. The goal is to get the packed cell volume back to the normal range and keep (or get) the patient out of shock. Food is withheld for at least 12 to 24 hours and then gradually introduced after the vomiting has resolved. Symptomatic treatment for nausea and belly discomfort is typically included, as is antibiotic therapy. One to three days of hospitalization is commonly required for treatment.

With early and aggressive treatment, life-threatening complications are generally avoided and dogs return happily home. In the case of Sam, he unfortunately required four days of intensive care, including nutritional support through a feeding tube as pictured, but I am happy to report that he made a full recovery and went back home to Mom and Dad!

Wellness: Health Care
When Playful Pups Take “Having a Ball” Too Far
Causes and responses to a choking pet

Having “something stuck in the throat” is a common problem for our pets due to their curious natures and indiscriminate eating habits. Recently, I saw an adorable Bernese Mountain Dog named Clover after she had gotten a little over-exuberant with her tennis ball. She’d actually swallowed it. She presented for difficulties with both swallowing and breathing, and X-rays revealed that her distress was toy-induced.

True choking is actual interference with breathing caused by foreign material in, or compression on, the trachea (windpipe). Choking can occur due to an obstruction of the airway from a foreign object in the throat, severe swelling of the throat or constriction of the neck.

In order for a foreign object to cause choking, it must obstruct the opening to the airway—either directly (i.e., actually in the airway) or indirectly (i.e., compressing on the airway), as in the case of Clover. Clover managed to swallow the tennis ball, but the ball was large enough to cause compression on her trachea, making breathing difficult.

Severe throat swelling can also cause choking and is usually associated with an allergic reaction or response to trauma. The tissues within the throat can swell and block the opening to the airway.

Constricting neck injuries are usually associated with collars and ropes. Dogs whose collars become tangled can choke due to the constriction of the neck from the tightness of the collar. In severe cases, dogs and cats can hang from collars, leashes and ropes.

When I lived in Colorado, my immediate neighbor came home one day to find that her two dogs became “hooked” together by collar and jaw; the larger dog’s mouth slipped under the loose collar of the puppy while playing and they couldn’t get free; the struggle resulted in strangulation of the puppy. This was a devastating experience for everyone. Please take this moment to check your pets’ collars and ensure that they are the proper size.

Common signs of choking:

  • Drooling
  • Gagging
  • Difficulty swallowing
  • Difficulty breathing
  • Pawing at face
  • Regurgitation
  • Anxiety and distress

If you observe any of the above signs, seek veterinary care immediately.

If you live far from veterinary care or do not have immediate transportation, the following measures may buy you some time while you are arranging for medical attention:

If you notice that your pet is choking, remove any item that may be constricting the neck, such as a tight collar. If you can do it safely, examine the inside of the mouth and remove any foreign object you see, but do not attempt to remove an object unless you can see and identify it.

If you cannot easily remove the object, lift and suspend a small animal with the head pointed down. For larger animals, lift the rear legs so the head is tilted down (like a wheelbarrow). This can help dislodge an item stuck in the throat. Another method is to administer a sharp hit with the palm of your hand between the shoulder blades, which can sometimes dislodge an object.

If this does not work, a modified Heimlich maneuver can be attempted. Grasp the animal around the waist so that the rear is nearest to you, similar to a bear hug. Place a fist just behind the ribs. Compress the belly three to five times with quick pushes. Check the mouth to see if the foreign object has been dislodged.

If your pet is unconscious, perform a finger sweep. Open your pet’s mouth and do a finger sweep by placing your finger along the inside of the mouth, sliding it down toward the center of the throat over the base of the tongue, and gently “sweeping” toward the center to remove any foreign material. Warning: There is a structure deep in the throat (the Adam’s apple) that feels like a smooth bone. Do not attempt to pull it out!

Melanie Monteiro, author of The Safe Dog Handbook, demonstrates these techniques.

What else could it be?

More times than not, what people believe to be choking, is actually an attempt to vomit or cough. Many pet owners will seek veterinary care because they believe their pet has something stuck in its throat, however, it is far more likely that your pet has something mild and infectious, such as tracheobronchitis (also known as kennel cough), and he or she is coughing rather than choking.

Choking versus coughing: With choking, the pet has difficulty inhaling; with coughing, the pet can inhale almost normally.

A few tips to help prevent a trip to the ER:

  • Make sure your pet has a collar that fits properly. Collars that are too tight or too loose can create serious injury and possibly death.
  • If you use a tie out, do not let your pet have sufficient slack to allow jumping over fences or off of decks and patios.
  • Like human children, keep all choking hazards, such as small items and toys, away from your pet. Super Balls and “mini” tennis balls for smaller breed dogs are also a common cause of upper airway obstruction in large breed dogs.

Clover and her experience prompted me to write this blog. I hope it will help prevent, or save, another pet in the future. Clover made a full recovery following the endoscopic removal of the tennis ball that she swallowed and she continues to do well!

 

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