Wellness: Health Care
Canine vertigo is treatable but scary to witness
I jolt awake in the middle of the night to the sound of one of my three dogs throwing up. My first thought is, glad the floors are concrete and easy to clean. The moon provides enough light for me to make my way to the kitchen, where I see Meadow, my 10-year-old Alaskan Malamute, standing with her head slightly lowered, a small pool of yellow vomit on the floor in front of her. Her front legs are splayed wide.
“Oh, Meadow girl, I’m sorry you’re sick …” I murmur as I approach. Before I can reach her, she stumbles and falls hard to the floor, then struggles to stand up. Stumbling like a drunk, she slams to the floor again. What the hell’s going on?
Meadow, who weighs more than 90 pounds, continues trying to stand. I hold onto her collar, using my other hand to steady her. When she falls, she crashes into my legs with all her weight, almost taking me with her. Not wanting to hear that heart-wrenching thud again, I use my body to prevent her from standing. She moves awkwardly, head swaying, fighting my downward pressure.
She finally stops struggling, but is clearly distressed. Her front legs are spread out in front of her, her chest is barely on the floor and all her weight is on her elbows. One of her hind legs is pinned under her hips, the other one extended out to the side. She pants fast and heavily. She can’t possibly be comfortable, but hasn’t let out any cries of pain and resists my attempts to rearrange her legs.
I turn on an overhead light, then lift her face toward mine. I’m confronted with one of the most frightening sights I’ve ever encountered: Meadow’s eyes are darting rapidly from side to side, as though every neuron in her brain is on fire. Almost crying in fear and frustration, I’m completely stymied.
I’m also alone in a house without cell phone reception. Just me and my dogs. The nearest ER vet clinic is three hours away, but I can’t get Meadow into the car without help. “Meadow, look at me.” I sense that she’s trying to focus, that she hears me, but she can’t make her eyes stop moving. “Meadow, you cannot leave me, not now, not here,” I say to her, trying to quell my own fear that she’s dying and there’s nothing I can do prevent it. I have to do something.
Telling Meadow to stay, I quickly dress and drive the quarter-mile to my closest neighbor’s house. Amazingly, despite the hour, they get their vet on the phone. After hearing the pertinent details, the vet makes an instant diagnosis: “She’s having a seizure. It might be the only one she ever has, or she might have more. She may have brain damage, or she may not.” Brain damage? Not good, although at least I can stop worrying that she’ll die tonight. But the eye thing, her inability to stand; it was going on a good 15 minutes before I left to come here, I argue mentally, thinking a seizure should be a quick thing, like the one I’d witnessed in a friend’s dog with epilepsy. “Seizures can last anywhere from a minute to a couple of hours,” the vet informs me, as if reading my mind. “Should I bring her to you tonight?” I ask. “No,” he replies, “there’s nothing to be done. Just watch her so she doesn’t fall down and hurt herself.”
When I get home, Meadow hasn’t moved, and is still exhibiting the same symptoms. I make a bed next to her on the floor and watch, and wait. As the night wears on, Meadow’s eyes finally quit darting, and eventually—around 5 am—she puts her head on the floor and sleeps on her side. I lay with her, stroking her fur, still trying to figure out what’s happening. It just doesn’t fit my idea of a seizure. Then suddenly, I remember: three years earlier, I’d had a sudden case of extreme dizziness, and my own eyes had danced uncontrollably, just like Meadow’s. I had awoken one morning to a world spinning out of control, unable to stand without falling or slamming into walls. Even rolling over in bed made the world heave and lurch. An ER doctor diagnosed vertigo, likely the result of a severe head cold that had affected my inner ear. A drug resolved my symptoms within 20 minutes, although I had to keep taking it for a week.
Can dogs get vertigo? I wonder as I lay there, stroking Meadow’s body. As it turns out, the answer is yes. In dogs, it’s called vestibular disease. Just about any creature with ears and a brain stem can suffer from vestibular disorders.
Vertigo (from the Latin vert(ere) = whirling or turning around) is a type of dizziness, a sense of motion when one is stationary, due to a dysfunction of the vestibular system in the inner ear. It is often associated with nausea and difficulty standing or walking.
“Vertigo is a human description of a feeling; dogs can’t tell us what they’re feeling, so vestibular disease is the term used,” says Beverly Sturges, DVM, associate professor of clinical neurology/neurosurgery at the UC Davis School of Veterinary Medicine.
According to Dr. Sturges, the most frequent cases are referred to as idiopathic or “old dog” vestibular disease because it’s most often seen in older dogs and there’s no obvious cause. “It’s benign; we still have no real understanding why it occurs,” she says. “It’s self-limiting, [requiring] no treatment except supportive care and comforting the dog,” she adds. The second most common cause is infection—especially Rocky Mountain spotted fever—or inflammation.
Dr. Sturges describes two broad categories of vestibular disease: outside the brain, and inside. “When outside the brain, it involves the middle or inner ear and is referred to as peripheral vestibular disease. This type is more treatable, with a better prognosis,” she says, and includes the old-dog syndrome. “Inside the brain means it involves the brain stem and is referred to as central vestibular disease. In small breeds—Maltese, Yorkies, Pugs, Poms—it’s usually caused by a non-infectious inflammation of the brain stem, often referred to as inflammatory brain disease. It occurs mostly in younger dogs [less than] two years of age. In larger breeds, central vestibular disease is usually caused by brain tumors [putting] pressure on the brain stem. Or, sometimes, trauma to the head.” Symptoms of central vestibular disease may be more subtle, with gradual onset.
That frightening eye-darting I saw in Meadow? It’s called nystagmus, a rapid, involuntary eye movement, side to side or, less frequently, up and down. “Nystagmus is not seen in all cases, but [it] is common,” says Dr. Sturges. “It lessens as the dog gets used to the sensation. Nystagmus can be profound in old-dog vestibular disease; a few days, or perhaps one to two weeks later, it’s almost always gone. It’s a reliable symptom: if there’s nystagmus, it’s vestibular disease and not usually a seizure. But you can see a drunken gait—ataxia—and other symptoms without nystagmus and it could still be vestibular disease.”
Diagnosis is based on a description of symptoms, or better yet, actual observation of symptoms. When appropriate, a vet will do a CT scan or an MRI to see if there are tumors or brain swelling. The type of nystagmus observed (horizontal versus vertical) and the direction of the dog’s head tilt (another common symptom) can help a neurologist differentiate between peripheral and central vestibular disease. Other issues involving the inner ear, or ear infection, will be ruled out if symptoms persist.
Treating central vestibular disease in dogs depends on the type and cause. “We’re pretty good now at removing tumors from the brain stem,” says Dr. Sturges. “If there’s inflammation and fluid, that can be drained surgically if necessary. We can prescribe antibiotics or an antifungal. When a vascular cause is suspected—a temporary or permanent lack of blood supply—vestibular issues usually get better on their own,” she says. “Toxins are another possibility. Metronidazole [Flagyl] and a few other medicines can cause toxicity, including vestibular disease; taking the dog off the drug and substituting another can resolve it.”
A sudden onset of acute symptoms and an absence of other physical findings usually mean peripheral vestibular disease. You and your vet may elect to wait a few days to see if improvement occurs before doing extensive diagnostics. After some online research, this was the choice I made for Meadow. Some vets will prescribe corticosteroids to reduce swelling and antibiotics just in case the cause is inside the brain. Ultimately, the final diagnosis of old-dog vestibular disease is made by the self-limiting nature of the symptoms. According to Dr. Sturges, 5 to 10 percent of dogs who experience this problem may have additional episodes.
Unfortunately, like Meadow, many dogs with vestibular disease are initially misdiagnosed as having seizures. In some instances, unable to afford expensive diagnostics or consult a neurologist, the distressed owners put the dog down, fearing he or she has suffered brain damage and won’t recover, or will suffer repeated seizures in the future. “That’s sad,” says Dr. Sturges. “There’s no reason to put them down. We don’t often see brain damage in dogs. A seriously long seizure could cause damage, but don’t jump to euthanize, even in cases of seizure,” she emphasizes.
Granted, sudden onset of vestibular disease can look like a seizure; the two are often hard to distinguish. “A neurologist could maybe tell the difference,” says Dr. Sturges. “An EEG to measure brain electricity and some other tests could help differentiate. But actually seeing the episode is the best way to diagnose. A video—everyone has cameras and video-cams these days—would be very helpful.”
For those who have never experienced vertigo, let me assure you: it’s sudden, overwhelming and incredibly frightening. You don’t know what’s happening, or why, and your brain seems disconnected from your body. Dogs must experience similar fear. And it can be dangerous, depending on when and where it occurs. Both Meadow and I were lucky; we were safely at home and our falls didn’t cause injury. Growing up in a family of aviators, I remember hearing whispered talk among pilots about vertigo, how deadly it can be during flight; it was the one thing they seemed to fear. Then, I couldn’t understand how simply being dizzy could cause a pilot to lose control of an airplane. Now I do. In fact, vertigo is thought to be the most likely reason the private airplane piloted by John F. Kennedy, Jr., and carrying his wife and sister-in-law crashed into the ocean off Martha’s Vineyard in 1999, killing all three. With vertigo, you literally don’t know up from down. Remember white-knuckle rides on that spinning playground equipment? When you tried to get off, you’d stumble and fall to the ground, head still whirling. That’s vertigo light. The real thing is more intense, longer lasting and much scarier.
Meadow and I eventually fall asleep. Around 7 am, I’m awakened by movement. I open my eyes to see Meadow sitting up. “Meadow! Good girl!” I say excitedly. This is progress; this is huge. “Do you want to go outside?” Before I finish the sentence, Meadow is leaning forward to get her hind legs underneath her. Helping her up, I usher her unsteadily toward the door. Out in the yard, she immediately pees and poops. I’ve never before been so excited about normal bodily functions. We head back into the house, where she goes straight to her normal sleeping spot beside my bed. Her gait is wobbly, but she’s moving under her own power. As she settles down, we both heave a huge sigh of relief.
Within a few days, Meadow’s gait is back to normal. She doesn’t have the lingering head tilt common with vestibular disease, but displayed every other symptom. Follow-up blood work discloses that she’s hypothyroid, a possible cause of vestibular disease.
After the dust settled, I shared my experience with friends. Many had similar stories involving taking their dog to a veterinary emergency clinic. One - a vet - has seen several cases in her clinic. Sharing our stories can help prepare us in the event our dogs – especially our old dogs – suffer a sudden episode, making it less scary. Seek medical treatment when appropriate, but if a diagnosis doesn’t ring true, trust your own observations and get another opinion. You know your dog better than anyone.
An online search of “vestibular disease in dogs” and “nystagmus” brings up YouTube videos of dogs showing classic symptoms such as head tilt, drunken gait (ataxia) and nystagmus. The videos are hard to watch, but being aware of the symptoms of vestibular disease could save you a night of fear and stress, or help you notice warning signs of central vestibular disease, allowing early intervention and an increased likelihood of a good outcome for your dog.
Wellness: Health Care
Chasing their tails, eating grass and rolling in garbage—should you worry?
From humping to “targeted” sniffing, our pups have a plethora of odd habits—at least to those of us who walk on two legs instead of four. While no one knows for certain the exact “why” behind these behaviors, we do have some theories. And until dogs learn to speak human, divulging their best-kept secrets, we’ll just have to continue to make educated guesses about this weird-but-true realm of doggy deeds. The key is recognizing if a behavior signals poor health.
When puppies chase their tails, it’s like babies grabbing their toes—and this is a normal way for them to explore their bodies. But like anything in life, moderation is key, and problems can arise if this behavior becomes compulsive. So, how do you determine if your pooch has a case of Canine Compulsive Disorder? It comes down to whether you can distract them from this behavior. If your dog would rather chase her tail than go for a walk, she may have a compulsive disorder and veterinary assessment may be needed.
It can be common for dogs to drag their bottoms across the ground after doing their business, particularly if their stool is loose. But if this behavior is noted frequently throughout the day, this may be a sign of impacted anal glands, a condition that can have serious complications if left untreated.
Watching your dog get personal with his stuffed toy can make you want to look away, but it’s not abnormal. Many dogs discover that humping feels good, it can relieve stress or serve as an outlet for excessive feelings of exuberance and excitement. Both males and females are known to partake in this behavior, though males do it more often.
People often think that dogs eat grass when their stomachs are upset or they are ill. However, a good ol’ lawn actually serves as a gourmet snack to many dogs. As omnivores, they like to eat their meat and veggies, too. Eating grass in moderation is a normal part of a dog diet, and a walk in the park for my dogs always includes a stop at the grass buffet. That said, if all of a sudden you see your dog frantically binging on grass, this could be the sign of distress, and a call to your veterinarian is in order.
It is general custom for Spot to greet Rover with a sniff of the behind, but why share this custom with us? Bad manners? Well, not according to the canine code of conduct, as this is a perfectly acceptable way of collecting personal information about one another, including humans. So the next time you are surprised by a nosey nudge, just know that you are being greeted and assessed (and don’t worry, dogs generally won’t be offended if you just give them a pat on the head in turn).
[Recently, Bark columnist Julie Hecht, MS, took a light-hearted look at the phenomenon.]
Gross, right!? I’m asked about this all of the time and all I can do is give an empathetic cringe of the nose and a shrug of the shoulders. (I know the score: My dog Mickey used to raid the cat’s litter box, proudly returning with “kitty cigars.”) As stomach-turning as this is, eating excrement is a surprisingly normal behavior for dogs. In the early stages of domestication, dogs performed a hygienic function of cleaning up their own feces. Additionally, their digestive system is very efficient and they can actually get some quality nutrients out of it—although I can think of much better sources.
Rolling in garbage
When we see a decaying animal or a pile of garbage, our first inclination is to step around it … waaaaay around it. But, keeping true to our dog’s oddities, it is their greatest desire to jump right in, getting a good coating of ick with a strategic roll. The more foul the smell, the stronger the lure, and the more joy that is experienced by our now perfumed pups. One theory is that dogs like to cover their own scent with horrible odors to make it easier to surprise prey. You probably can’t curb your dog of this desire, so your best hope is to spot smelly things first and steer your pal in a different direction.
I hope this has shed some light on a few odd dog behaviors. Funny, as I sit here, I find myself looking over to my own dog, Bauer, wondering if he is looking back at me thinking, “Wow, there she goes again, sitting in front of that computer when she could be outside playing with her ball. Now, that’s just weird.”
Wellness: Health Care
What to do while you’re deciding what to do
These poignant signs of aging may pull at your heartstrings, but may not mean much about your older dog’s overall health. As time goes by, though, signs of aging may become more dramatic: nighttime wandering, disorientation, difficulty with stairs, accidents in the house.
At this point, your dog is entering a twilight time. You can see the horizon—a last illness or that last visit to the vet—but you’re not ready to give up. With a little effort, you can provide your dog with the comfort he needs during the last bit of time you share. (Providing him with love is a given.)
This past summer, we nursed our smallish, mixed-breed dog, Shucks, through his last illness, near the end of his almost-16-year span. Given his age, we were making more frequent visits to our veterinarian, Dr. Arthur Wohlfeiler. Indeed, we made it through this challenging time thanks in part to the moral support and help of our vet, and we accumulated some great tips and helpful products along the way. Dr. Nicholas Dodman’s Good Old Dog: Expert Advice for Keeping Your Aging Dog Happy, Healthy, and Comfortable also provided lots of good advice. Here are some of the things we learned.
Food and Water
If your old guy loses track of his water dish, or is physically unable to get to it, it’s up to you to keep him hydrated. Bring the water to him. You may have to hold the dish in front of him for a minute and wet his mouth so that he gets the idea. And make the water more interesting. Dr. Dodman suggests dissolving sodium-free chicken bouillon in his dish. Both the aroma and the flavor will encourage him to drink. Adding a half-cup or so of water to his food (both dry and canned) will help hydrate him as well; he won’t mind the soupiness.
As with people, dogs’ dietary needs and preferences usually change as they age. Try adjusting his feeding schedule; reluctant eaters can often be tempted by small portions throughout the day. Continue to feed him his regular food as long as he likes it. Switching from dry food to canned, however, may help a dog whose teeth are worn or damaged, and its stronger smell may be more enticing to him.
While your dog’s sight and hearing may decline, his sense of smell doesn’t. If he can smell his dinner, he’s more likely to gobble it. Warm the food slightly in the microwave, and add bouillon or some other flavorful treat to pique his interest. Don’t automatically switch to a “senior dog” diet. This use of this term is unregulated, and, depending on an individual dog’s specific health issues, some of these formulations can compromise his health. (Be sure to talk to your vet about any dietary changes you’re considering.)
You have options when it comes to encouraging your old dog to eat if his enthusiasm has waned. For example, feed him from one of your own dinner plates. For whatever reason, food from a “human” plate is sometimes more appealing than food in his humdrum bowl. Keep the dog’s plate on the table next to yours when you’re eating and as soon as you’re finished, give your dog his dinner.
Some dogs find it difficult to lower their head to their bowl; raising the bowl in an elevated feeder or even on a low little bench helps.
Provide your dog with a buffet. In a casserole-type dish, arrange an assortment of foods in small piles and let him “graze.” After he’s eaten the things that most strike his fancy, combine the leftovers in a small ball or two and handfeed it to him, if necessary.
Take care that you’re not forcing the issue; a lack of interest in food and water is, of course, a sign that your dog is near the end. Respect the message he’s sending.
Improve traction by tacking a piece of outdoor carpet to slippery stairs and using nonslip rugs inside. If you have a neglected yoga mat rolled up in your closet, it can also be used both inside and out as a traction aid; it’s easy to cut to size if you don’t need the entire length or width.
Rearrange your furniture, as much as you’re able, to facilitate your dog’s movement around your home. Keep debris off the floor, as even a stray magazine or slipper can trip up an arthritic dog. Block areas where he might get stuck.
Doggie steps and ramps are available online and in pet stores. Be aware, however, that many older dogs are reluctant to change their habits, and high steps and ramps might scare them. Never force their use.
Towels are great tools. You can use them to wrap your smaller dog up when you carry him outside, or, if your dog is a big guy with mobility issues, you can use a large towel as a sling. (You can also purchase slings at pet stores and online.)
Keep It Clean
During our dog’s last summer, we kept a plastic storage bin filled with water in our yard. The sun warmed the water, and it was always there to rinse him off if he soiled himself. That having been said, keep in mind that your old dog is susceptible to changes in temperature. If you’ve had to get him wet, dry him and warm him as quickly as you can.
Keep rags, rags and more rags handy at all times and check out your local pet store for special drying towels. Your elderly dog can’t shake off the water like he used to and these thirsty towels are a great help.
Believe it or not, there are such things as doggie diapers, and you might want to try them. Other products intended for housebreaking puppies can also help with your elderly dog. Housebreaking pads provide a comfortable bed if he’s having accidents in his sleep; washable waterproof pads are also good for this use. (Get several so you always have one or two clean; medical supply stores and children’s bedding outlets often carry them.) Odor removers will help keep your house livable.
Your dog’s last weeks, trying though they may be for you emotionally, can be a gift. They are an opportunity for you to reach a consensus on hard final decisions and to share your feelings about the approaching loss. Even more important, they give you one last chance to show the best dog in the world how much he or she means to you.
Dog's Life: Lifestyle
The 2 Million Dogs Foundation supports comparative oncology efforts
It seems everyone I talk to has a friend, relative or pet affected by cancer. The disease has touched way too many loved ones, both human and canine. As it turns out, when it comes to cancer, we may have more in common with dogs than we think. For instance mammary tumors are the most common tumors in intact female dogs and breast cancer is the most commonly diagnosed cancer in women. As more similarities are found, collaboration is becoming more common between veterinarians and doctors through comparative oncology.
Now there’s an organization dedicated to increasing awareness and funding for this growing field. Luke Robinson created the 2 Million Dogs Foundation while walking cross-country in honor of his Great Pyrenees who he lost to cancer in 2008. The organization aims to better understand the links between human and companion animal cancer, encourage more collaboration between institutions, develop new approaches to research, and fund translational cancer studies benefiting both pets and people.
Earlier this month the 2 Million Dogs Foundation presented a $50,000 check to Princeton University to help fund their Molecular Study of Canine Mammary Tumor Development and Progression research. The money came from a series of Puppy Up! Walks held all over the country last year.
Comparative oncology is a fascinating field and it’s great to see an organization that is dedicated to supporting research benefiting both humans and canines affected by this horrible disease.
Wellness: Health Care
There’s more to it than meets the nose!
As much as we might hate to admit it, flatulence is a normal biological function. A surprising amount of air is swallowed just with the simple act of eating, and if this is not burped out, it must exit through the other end. The amount of air swallowed tends to be increased when dogs feel they must eat quickly or in brachycephalic breeds (dogs with a compressed upper jaw and a short muzzle) that tend to breathe more by mouth than by nose.
Flatulence comes from an excess of gases in the intestinal tract. These gases may represent air that has been swallowed, gas produced in the biochemical process of digestion, gas diffusion from the bloodstream or gases produced by the bacteria that populate the intestinal tract. Contrary to popular belief, more than 99 percent of the gases that pass from the intestinal tract are odorless (whew!).
Dietary fiber in pet food is not easily digested by the pet’s own enzyme systems, but it is, however, readily digested by the gas-producing bacteria that live in the colon. As fiber is broken down here, hydrogen sulfide is produced, which is the cause of the really stinky gases. Therefore, a diet that is heavy in fiber further promotes a “happy environment” as well as “food” for the bacteria, ultimately producing more gas.
Helping clear the air
Offering your pet a highly digestible, low-residue diet is one of the major ways to combat flatulence. A low-residue diet is designed to reduce the frequency and volume of stools, while prolonging transit time through the intestine. It is similar to a low-fiber diet, but includes restrictions on foods that increase bowel activity. Changing to a low-residue diet means that most of the nutrients of the food are digested and absorbed by the pet before they reach the colon, where the gas-forming bacteria live. Less food for the bacteria equals less bacteria, which equals less gas formed.
Sometimes just going through a case and/or bag of such a low-residue diet solves the problem and the pet can return to a regular food afterwards. If necessary, the therapeutic diet can become the pet’s regular food. Low-residue diets are available through your veterinarian, pet supply stores or can be cooked at home (boiled white rice, skinned chicken, cottage cheese and balanced with vitamins and minerals constitute low-residue ingredients).
Other easy changes that can help include:
Are there some medical conditions that can increase flatulence?
Changing the diet and ruling out actual intestinal disease are of primary importance in addressing flatulence. Some disease processes that can cause an increase in flatulence include:
Medications and herbal and botanical supplements
Sometimes medication can help. Although there are many products available, most are unfortunately not as helpful as they are touted to be, or not labeled for animal use. There are more than 30 herbal and botanical preparations available to reduce gas in the stomach and intestines; however, the dosage, safety and efficacy are unknown.
If further therapy is needed, the following products have some basis and support that they may be of help for flatulence:
Some popular, but more questionable, products with regards to treating excessive flatulence include:
While flatulence is a normal part of everyday life, if the problem persists or seems severe, it is recommended that you consult with your veterinarian. Even our pets sometimes need a smog check!
Wellness: Health Care
Lay the groundwork for quick, low-stress treatment
Working in the ER, I see a full range of preventable predicaments that complicate addressing a pet’s immediate health crisis. I’d like to highlight four simple measures you can take as a pet parent to prevent distress and concern should an emergency arise while you are away or if you need to seek care outside of your normal veterinary relationship.
Records!! Keep a copy of every medical record, radiograph and diagnostic test in a file. It allows a new veterinarian to quickly understand your pet’s health status. This is especially important if your pet has a history of illness such as kidney failure, cancer or multiple/ongoing disease processes.
Your pet file should also include a copy of vaccination records. I often get last-minute calls to fill out a health certificate for airline travel, but am unable to do so because owners do not have proof of their pet’s rabies vaccination. As is the case with most emergency hospitals, I am unable to administer another vaccine because we don’t keep any in stock (this is an area of health care that is left to general practitioners).
Advanced directive: I strongly recommend that every pet owner have in place an advanced directive with regards to their pet’s continued care in the event of physical decline in their absence. [Here’s a copy of an advanced directive form we provide that you can download and print.] This is especially important if you share your life with a geriatric pet or one who has ongoing medical issues or failing health. Discuss with your pet sitter, family members and your veterinarian your wishes and have a clear understanding of treatment limits in the event you cannot be reached.
I cannot tell you how many times I have seen family members or caretakers struggling to make the difficult decision of euthanasia in the event a pet is suffering and the owners are out of contact.
Pre-arrangement for payment in case of an emergency: Along the same lines as an advanced directive, pre-authorization for treatment is strongly recommended. It is not uncommon for owners to leave their pets in the care of a boarding facility, an in-home pet sitter or a family member during vacation, and then something goes wrong. It is heart-wrenching to navigate a situation where the temporary guardian brings in a pet and has no means of payment or way of contacting the owner to obtain approval for a treatment plan. We try to work as best as we can with these situations, but you can only imagine how heavy these decisions can be for everyone involved.
A common example is a pet who has been hit by a car. Although severe trauma can have an excellent outcome with treatment, the cost of stabilization and management can quickly reach thousands of dollars. Financial responsibility and decision to pay for this level of treatment is a big burden to place upon your sitter. I would give anything for this to be a world without financial concerns, but the hard reality is that emergency hospitals generally will not extend credit on good faith, especially if you have no previous relationship with them.
So before leaving town, stop by your local emergency clinic and your regular veterinarian to sign a release of payment in case of emergency. Your credit card number can be kept on file with your signature authorizing treatment in event of an emergency; you can also set the parameters of care at that time.
Plan ahead and anticipate medication shortages: I get many calls from owners asking to refill a pet’s medication because they are leaving town the next day and their regular vet is closed. What many people are not aware of is that legally we are not able to provide this service unless we perform a full physical examination on the pet, and with that, comes the cost of an emergency exam fee.
Although it can be understandably frustrating to have to pay an exam fee for an otherwise healthy pet for a “simple refill” of a medication, legally, hospitals cannot serve the role of a dispensing pharmacy. By law (and risk of our veterinary license) we cannot OK a refill of a medication without examining your pet, no matter how benign or common the drug. Because of this, I recommend keeping an extra bottle on hand, or getting in the habit of refilling your pet’s prescriptions when the bottle is approaching three-quarters empty.
Another tip: If you fill your medication at a human pharmacy, and it is a drug and dose that stays constant for a well-controlled disease state (such as medicated drops for eye disease or phenobarbital for seizures), ask your veterinarian to write an additional refill on the written prescription.
I hope these four simple proactive steps help raise awareness of potential situations that can arise while you are away, and help you to formulate a plan well in advance should any situation unexpectedly arise.
Wellness: Health Care
Make 2012 happier and healthier for you and your pup
Veterinarians love putting together a plan of care for their patients—so why should New Year’s be an exception? Here are my suggestions for ten (I think fairly reasonable) resolutions that can make a big improvement for your dogs and you. For those who’ve already embraced many of these good habits, this list can serve as a chance to pat yourself on the back.
A few habits to encourage your dog to consider
Do you make New Year’s resolutions? What new behaviors are on your list?
Wellness: Health Care
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
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
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:
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:
“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!
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