Wellness: Health Care
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:
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.
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!
Dog's Life: Lifestyle
See what the symptoms look like in real life
Everyone with a large, deep chested dog is always worried about bloat (any breed can get bloat, but this demographic is disproportionally affected). Bloat is particularly scary because of how fast the condition becomes serious.
When bloat occurs, the dog’s stomach fills with air, fluid and/or food. The enlarged stomach puts pressure on other organs and can cause difficulty breathing and even damage to vital organs.
According to the ASPCA, even with immediate treatment, approximately 25 to 40 percent of dogs die from this condition. But certainly the odds are much better the sooner the dog can get emergency treatment.
I'm familiar with the signs of bloat, but the video below helped me learn what the symptoms look like in real life.
Roscoe, the dog in the clip, was adopted from Akita Rescue Mid-Atlantic Coast. The video was taken when he first got to his new home. No one present had ever seen bloat before. As soon as they realized Roscoe was sick, they rushed him to the emergency vet where he received life-saving treatment.
Thanks to this video, I feel much more confident that I could identify the symptoms of bloat.
Wellness: Health Care
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
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
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.
News: Guest Posts
Mila comes through treatment with flying colors
Back in August, I wrote about a nine-year-old German Shepherd named Mila, who was undergoing heartworm treatment. She’s a foster dog being cared for by Jean, a volunteer for Big Hearts Big Dog Rescue in Western New York. Jean created a blog to report on Mila’s progress and more generally about heartworm prevention and treatment. Mila is Jean’s third heartworm-positive foster dog.
For months, Jean worked hard to keep Mila quiet, cool and comfortable—while the Immiticide killed off the dreaded heartworms. One of my favorite posts was about “Dr. Bruno,” a former therapy dog who comforted Mila and alerted Jean to changes in the patient’s recovery. What a wonderful idea to include a therapy dog for a canine patient.
I checked back in with Jean this week and she reported that Mila’s treatments are concluded and she is doing well, although she has lost muscle tone from her months of bed rest.
“We need to bring that back slowly and carefully because she has some pre-existing ortho issues,” Jean writes. “So we are starting with simply walking the yard, just like we did when she came into foster and had been kenneled for months.
“Mila is also a very smart girl who has a bit of a mind of her own, and for the time of her treatment she did not have any expectations for her behavior other than staying quiet, so we are doing some NILIF [nothing in life is free] to get that back in shape too! She remains upbeat and social and just needs everything in smaller doses for now as she gets back in the swing of things. She is still cute and funny—none of that lessened!”
She might even be heading for a forever home; someone has submitted an application to adopt her. There are still hoops to be jumped through—home visits and references, etc., but it’s “very exciting and I am keeping my fingers crossed that in the next month this will be how the blog will close,” Jean writes.
I’m awestruck by all that Jean has done to create a second chapter for Mila.
Meanwhile, on the heartworm front, it’s important to remember that although the weather is cooling around the country, heartworm remains a threat. “Unfortunately for our pets, mosquitoes are hardy and have proven their ability to survive year-round across the United States,” says American Heartworm Society president Wallace Graham DVM. “Warm microclimates, both outdoors and indoors, can foster mosquito survival and pets can facilitate the spread of heartworm.” Pets can also contract heartworms when their owners transport them from one area of the country to another.
Learn more about potentially lethal heartworm at Jean’s Big Dog, Big Heartworm blog and at the American Heartworm Society.
Wellness: Health Care
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, 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.
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.
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.
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
Foxtails are another source of the toxin
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!
Wellness: Health Care
A Vet’s Perspective
Gilberto had it bad. when I asked, “When did you get Carly?” he recited the exact date he had adopted his beloved Pointer cross from a shelter two years earlier.
“They told me she only had a couple of months to live — cancer — and, for that reason alone, no one was going to take her. Not to mention her problem with other dogs.”
Gilberto and Carly had been sequestered in a private room, isolated from the waiting-room hubbub. She seemed like a perfectly socialized, gentle, malleable creature, though the swelling around her hock gave me pause.
“She was found wandering the New Jersey Turnpike. Her body was covered with scars and there were deep indentations over the bridge of her nose from wearing a muzzle. The shelter thought she had been used as a bait dog.”
“I’m not sure what you mean by ‘bait dog,’” I said.
“Among other awful things, an intact female dog to excite and wind up male dogs before a dog fight.”
Appalled, I shook my head. I didn’t know what to say. No wonder Carly demonstrated fear aggression around other dogs.
“My mother was visiting for the summer from Brazil,” said Gilberto, “so I thought, why not; I’ll give Carly a home and some quality time. It felt like a winwin for both of us, and Carly’s fantastic with people. Naturally, I spoiled her — she got to sleep with me on my bed, she always got the last slice of pizza and where was the harm in taking her out for ice cream? But summer came and went and Carly seemed absolutely fine.”
“What kind of cancer are we talking about?” I asked.
“Breast cancer. The pathology report said it had already spread to her lymph nodes.”
I frowned into a slow nod. This certainly sounded grim. “My friends started ribbing me, telling me I’d been suckered into taking her because of her aggression. But look at her — she’s great.”
Carly was investigating the room, sniffing the air, somehow catching the aroma of low-fat dog treats high on a shelf and out of sight. She seemed as affable a creature as one would ever want to meet.
“I arranged for pet-sitters when I was away from home, and started Carly on a more civilized diet. We also tried working with a behaviorist, with limited success. And here I am, two years later, with a dog who jumps off a bed and comes up lame.”
As touching and miraculous as Carly’s story was, alarm bells were ringing inside my head. The cancer diagnosis was detailed and specific. Shelters do not try to con to secure an adoption.
Carly was toe-touching lame on her right hind leg and, given the high risk of a canine encounter, I figured nothing would be gained by a “best in show” stroll up and down the corridor. Jump off the bed, roll an ankle and hey presto, lameness and joint swelling. But this swelling was all wrong: firm, focal and slightly above the joint. Was the cancer finally back? And if so, was the man who had taken on a death-row dog and treated her to a wonderful stay of execution, now — after all this extra time — in denial?
“There’s something not right with Carly’s ankle. I’d like to take an X-ray.”
Gilberto agreed and we hurried Carly into radiology like we were smuggling a rock star into a building full of restless fans. The films confirmed my suspicion: subtle boney changes suggestive of metastatic spread of a cancer.
“Can I get a copy of the image?” asked Gilberto. “My wife is a pathologist. I’d like her to take a look at the films.”
“Absolutely,” I said, wondering if perhaps he didn’t believe me. For a guy who took on a dog knowing she was going to break his heart, he seemed completely broadsided.
“I would also suggest that we take a series of chest X-rays to see if it has spread to the lungs.” Gilberto agreed. Sadly, the X-rays confirmed the presence of golfball- size masses within the lungs.
I offered the possibility of a biopsy, set him up for a consultation with oncology and, most of all, encouraged him to go home, absorb the information, speak with his wife and then give me a call. In the end, Gilberto chose to manage Carly’s pain with medications at home.
Some weeks later, I checked in with him.
“I almost wish you’d never taken those X-rays,” said Gilberto.
“You were doing your best, but sometimes I feel as though it would have been better not to know.”
I said nothing, but was reminded of the delicate tightrope act we veterinarians constantly perform. Some dog owners seek a diagnosis and treatment at all cost. Others simply seek assurance and support that they are doing the right thing. It’s never easy to find a balance. Gilberto was the kind of pet owner most of us can only aspire to be — selfless, invested and humbled by how much we get back for how relatively little we put in.
“These days, I’m mainly working from home, which is great. I’ve always been into cooking, and recently, I made a big batch of fettuccine Alfredo; Carly loved it. She sleeps beside me every night, and I know she’s doing okay because she still freaks out when she hears a motorcycle.” I hope Gilberto knew that on the other side of the phone line, I was smiling. This remarkable man was being forced to anticipate the loss of his dog for a second time, and he was still awed by how much he stood to lose.
Wellness: Health Care
Great for handicrafts, terrible for dogs
We all have one—that bottomless black hole known as the “catch all” drawer, and it is not uncommon to find a bottle of Gorilla Glue tucked away in this vortex of odds and ends. People who do a lot of handiwork or crafts love this stuff, but unfortunately, so do our dogs; they find it to be a sweet, appetizing treat.
Why is it bad?
Gorilla Glue and Elmer’s ProBond are popular polyurethane-based adhesives that when ingested can cause serious problems, including death, if not properly diagnosed and treated. While classified as ‘nontoxic,’ these glues contain a catalyzing agent called Diphenylmethane Diisocyanate (MDI). When MDI-based adhesives come in contact with water they expand rapidly and create a hard foam material. The rate of this reaction is enhanced in warm and acidic environments, such as the stomach, and ingestion most commonly results in an obstruction. The reaction also produces heat, which can result in secondary complications such as thermal burns to the esophagus and stomach, which can also be life threatening.
What are the signs of ingestion?
Animals who have ingested these adhesives may present with a variety of nonspecific clinical signs including loss of appetite, restlessness, difficulty breathing, vomiting or a change in behavior. Signs generally develop within 15 minutes, but can occur up to 20 hours following ingestion.
What should I do if my pet ingests a polyurethane-based adhesive?
If ingestion is suspected, it is important that your pet see a veterinarian as soon as possible. A point to stress: Do not attempt to induce vomiting at home! The glue can expand and harden within minutes, and obstruction or injury to the esophagus (swallowing tube) can occur while your pet is in the process of vomiting. It should also be noted that ingestion of as little as 2 ounces will likely cause obstruction in a medium-size (50 pound) dog!
How is the diagnosis made?
Radiographs of the abdomen often show evidence of the glue mass. An important side note is that this radiographic finding can sometimes be mistaken for “food bloat,” which is when your pet ingests a large amount of food resulting in distention of the stomach— one is deadly and the other is not. History is a critical part of arriving at a diagnosis, and it’s important to mention if you have this type of glue in your home, even if you think your pet cannot get into the area where it is stored.
How is it treated?
In cases where an obstruction develops, surgery is needed to remove the glue mass. Prompt identification of the problem and medical care greatly improve your pet’s chances of a successful outcome.
As always, the best treatment is prevention: If you use MDI-based glues, please take extra precaution to keep away from pets.
I have personally treated three cases of glue ingestion in the past couple of years, and it is my hope that this information will prevent me from seeing case number four! As always, please feel free to leave comments or questions.
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