Veterinarian Shea Cox has enjoyed an indirect path through her professional life, initially obtaining degrees in fine arts and nursing. She later obtained her veterinary medical degree from Michigan State University in 2001 and has been practicing emergency and critical care medicine solely since that time. In 2006, she joined the ER staff at PETS Referral Center in Berkeley and cannot imagine a more rewarding and fulfilling place to spend her working hours. In her spare time, she loves to paint, wield her green thumb, cook up a storm and sail. Her days are shared with the three loves of her life: her husband Scott and their two Doberman children that curiously occupy opposite ends of the personality spectrum.
News: Shea Cox
Part 1 in a 4 Part Guide
August 23 2012
To identify an illness or abnormal situation, you must first be able to recognize what is normal for your dog. You know your dog better than anyone else and you will have to decide when an abnormal situation warrants professional help. Sometimes the condition is so serious it leaves no doubt. Frequently, however, the changes are subtle, or happen over a longer period of time, making noticing a problem more difficult.
Over the course of the following weeks, I will provide you with information on how to perform an at-home physical exam, helping to determine and establish what is normal for your pet. It is recommended that you occasionally perform this exam- while there is nothing wrong- so that you can begin to get used to what is normal. This practice will help allow for the early detection of changes in your dog’s health.
I will start with the basics this week: A good look, temperature, and how to obtain a heart rate. Next week will continue with a systems approach beginning with the head area, followed by the chest, and lastly, the abdomen. At the completion of these 4 blogs, you should have a complete home guide on how to perform a screening exam. Ready?!
First, before you start your hands-on exam, stand back and just simply look at your dog for a few minutes. The posture, breathing, activity level, and general appearance can really tell you a great deal. Get a good picture of your dog’s “normal” in its relaxed home environment—this mental snapshot will help you notice any subtle change.
Taking your dog’s temperature is an easy and important procedure. Use a digital rectal thermometer (the ear type is less reliable and mercury thermometers can break!). Lubricate the end with petroleum jelly and gently insert the thermometer into the rectum about 1 inch for small dogs and about 2 inches for larger ones. If it does not slide in easily, do not force it. And do not risk taking your pet’s temperature if you feel there is a risk of being bitten.
PULSE AND HEART RATE:
Learn to locate the pulse on your dog before a crisis. The best place on a dog is the femoral artery in the groin area (see picture).
Here’s how: place your fingers around the front of the hind leg and move upward until the back of your hand meets the abdominal wall. Move your fingertips back and forth on the inside of the thigh until you feel the “roll” of the artery and the pulsing sensation as the blood rushes through it. Count the number of pulses in 15 seconds and multiply by 4. This will give you the pulse rate in beats per minute. Pulse rate is a highly variable finding and can be affected by recent exercise, excitement or stress. Do not use the heart rate at the sole evidence that your pet is sick or healthy.
The heart rates that are listed are for healthy dogs at rest in their home, not for animals that are evaluated in a veterinary clinic where higher heart rates might be detected due to excitement, stress of a visit to the clinic, or disease.
Practice these essential skills and I’ll see you next week for all things head related, including the ears, eyes, nose, and mouth! See DIY Physical Exam: Part 2.
News: Shea Cox
The top 5 tick myths dispelled
August 17 2012
Disease-carrying ticks can pose serious health risks to both dogs and people, no matter what state you live in. The U.S. Centers for Disease Control (CDC) reports that ticks in every state can carry disease, and the number of tick-borne diseases is on the rise. Here in Northern California, they seem to be everywhere, and it is not uncommon for me to find an “incidental tick or two” during my physical exam. This usually leads to a tick-related conversation where I sometimes have to dispel a tick myth or two.
Fiction: “I heard that the best way to remove a tick is with a lit match, petroleum jelly, or alcohol”
Fact: None of these methods cause a tick to “back out” of the skin and can actually cause more injury. When you try to remove an embedded tick in this manner, you can actually aggravate it, causing the tick to deposit more disease-carrying saliva into the wound, and increasing the risk of infection. The best way to remove a tick is by using tweezers, grasping it as close to the dog’s skin as possible, and pulling the tick out with a steady motion. Dispose of the removed tick down the toilet or by placing it in rubbing alcohol.You should clean the skin with mild soap and water after its removal. You may see a little red circle (like a bull’s eye) or bump of redness on the skin at the insertion site following removal- this can be normal and may be visible for up to a couple of days. You should see your veterinarian if the region of redness increases in size or if it doesn’t go away within 2-3 days.
Fiction: “My dog doesn’t go hiking in the woods, so I don’t have to worry about exposure”
Fact: Ticks live on the ground no matter the locale, and this includes our urban parks and rural areas. Ticks typically crawl up blades of grass, looking to hitch a ride as our pets pass by. Ticks like to migrate upward, which is often why they’re found on the head.
Fiction: “Ticks aren’t a problem in the colder weather, so I only have to worry in the summer”
Fact: In most areas of the country, “tick season” runs from April to November, however, infection can occur any time of the year. For example, in the winter, some tick species actually move indoors, while other species make a type of “internal antifreeze” to survive during the winter months. This is often why veterinarians will recommend year-round tick prevention.
Fiction: “Lyme disease is the only illness that ticks can transmit to dogs (and their humans)”
Fact: While Lyme disease is the most widely known and common disease caused by ticks, there are other diseases including Rocky Mountain spotted fever, babesiosis (one of the newer discovered diseases, see Jane Brody’s article about it), and ehrlichiosis. These diseases can have equally devastating effects on our pets.
Fiction: “If I find a tick on my pet, or if I see the “bull’s eye” red ring on my pet’s skin, I should get a blood test because this will tell me if my pet has disease”
Fact: If your pet is ill, and you are aware of tick exposure, a tick-borne disease screen is highly recommended. However, it should be noted that lab tests run for tick-borne diseases are often negative on the first sample and require a second test in two to three weeks to confirm infection. Therefore, a negative test does not necessarily mean that your pet is free from disease. It should also be noted that many dogs with tick-borne illness do not experience any symptoms, especially in the early stages of disease.
And one last tip to throw into the mix: if you do attempt to remove a tick at home, make sure that it is actually a tick! I cannot tell you how many times I see a pet on emergency for an accidentally removed nipple! Ouch!
News: Shea Cox
Making the cost of pet care easier to swallow
August 14 2012
In many veterinary practices, dispensing of prescription drugs, nutritional supplements and parasite prevention makes up 17 percent to 20 percent of practice revenue. Historically, selling these products has been a relatively passive revenue source for veterinary practices. In the past, there has been little competition for products, and consumers did not routinely “shop around” for medications. However, that landscape is rapidly changing.
There is new legislation that is currently being discussed in congress that, if passed, will mandate that veterinarians provide a written prescription, even if the prescription is filled on the premise. This legislation is called the “Fairness to Pet Owners Act of 2011,” or H.R. 1406, which will allow pet owners to go to their neighborhood pharmacy for prescriptions, or to have them filled online. The legislation was modeled after the Contact Lens Consumers Act, with the intent of giving pet owners a copy of the written prescription so they can shop around.
The legislation calls for new rules regarding veterinary prescriptions that include:
• Requires veterinarians to offer written disclosures about off-site pharmacy options for prescription dispensing;
Many veterinarians and medical associations feel this idea is a tough pill to swallow and here’s why:
• The American Veterinary Association believes this law is redundant and will cause undue regulatory and administrative burdens on veterinary practices. They feel it is burdensome and unnecessary to require a written prescription be provided, as well as a written notification that the prescription may be filled elsewhere, regardless of whether or not the client is having the prescription filled by the veterinarian.
• The provision that requires the vet to verify the prescription, regardless of whether the pharmacy is accredited or licensed, which places the veterinarian in both a legal and ethical dilemma. At the same time, it puts consumers at risk.
• Clients already have the flexibility to fill a prescription at their veterinary clinic or off-site at a pharmacy of their choice. The AVMA is supportive of a client's right to choose where they have their prescription filled.
I see both sides of the fence, and overall, I feel that the concept is an excellent one; I just hope it doesn’t get lost in translation. I feel pet parents have the same right to shop around for the best prices on the medications they buy for their pets, just as they do for products they buy for themselves.
While the various lobbyists continue the battle of semantics, did you know? Yes, it is true: most states already do require by law that a written prescription be provided to you, should you just ask. Did you realize that you most likely have this option available to you? What are your thoughts with this proposed legislature after hearing “both sides?”
News: Shea Cox
Dilution is the solution to pollution
July 26 2012
It is a common misconception that "acid" in a dog’s urine is what causes the brown spots left behind on our lawns. However, the culprit is actually the high nitrogen content of the urine. Nitrogen is “the waste” in the urine and is the result of protein breakdown through normal body processes. Because a canine diet is very high in protein, there will be high levels of nitrogen, and you’ll be battling blemishes for as long as your pet uses the lawn for its place of business.
A repeated vet school mantra was, "dilution is the solution to pollution," and that concept holds equally true in the case of urine scald on our lawns. Therefore, the best way to help prevent brown spots is either by dilution or by addressing the external environment. Besides training your male dogs to pee through the fence onto your neighbor’s lawn (kidding!), here are tips to keep your lawn lush and green:
The most effective way to prevent grass scald is to the water the area immediately after your dog urinates. If you have easy access to a hose or a rain barrel, give the area a quick dousing. I also have a tub in my sink that I use to catch excess water when I’m at the sink; instead of letting it go down the drain, I collect it and use it to water my plants. This idea could be used to water the lawn as well, while remaining mindful of the environment.
Another intervention is the construction of a small graveled, mulched, or artificial turf area in the back or side of your yard. You can train your pet to "go to the back," and with positive reinforcement and praise, they will eventually and automatically head to that area to do their business. You can make this site visually appealing by placing potted hostas, ferns, or other greenery around the perimeter.
The kind of grass you put in your yard also determines how well it will tolerate dog urine. Fescue and perennial ryegrass are most resistant, and diluted amounts of urine (hosing down the spot like stated above) can actually act as a fertilizer. What are the least hardy of grasses? Kentucky Bluegrass and Bermuda grass are the most sensitive to urine scald. Another tip: if you fertilize your lawn, use a reduced nitrogen fertilizer.
Now a word for those over-the-counter medications that are touted to be "lawn-saving supplements." I personally (and strongly) caution against their use. Nothing you give your pet internally will safely stop urine from damaging grass, and the only appropriate interventions are those that address the environment- not the dog! The environmental changes discussed above may be more time-consuming work, but it’s a small price to pay if you wish to have both a lush lawn and a healthy pet.
These medications work by either changing the pH of the urine, or by adding salt to the body. And it should be reiterated: urine burn is a nitrogen problem, not a pH problem. When you use medications that alter the pH of the urine, you run the risk of causing urinary crystals or bladder stones in your pet. Certain types of crystals and stones thrive in the altered pH environment, which will create a much bigger problem than a lawn blemish. The other “lawn-saving supplements” are actually pills that contain high amounts of salt. This in turn causes your pet to drink more, thereby diluting its urine (dilute the grass, not the dog!). Giving your pet high amounts of unnecessary salt is not a good option, and this is especially true if your pet has underlying kidney or heart disease.
Another recommendation I have heard is the use gypsum salts and this is another option I caution against. Gypsum is calcium sulfate, and this material can cause eye, skin, oral, and respiratory irritation in our pets.
Since we’ll never be free from pee, I hope these tips have helped, and I’ll see you next week!
News: Shea Cox
The most common dog-park related incidents revealed
July 18 2012
The warmer summer weather correlates to an uptick in ER visits, many of which are related to dog park dilemmas. Interestingly, there has been a 34 percent increase in dog park utilization over the past five years, and these designated areas are the fastest growing segment of all city parks in the U.S.
With this increase in use comes the proportional increase in dog injuries. Veterinary Pet Insurance (VPI) recently sorted its database of more than 420,000 dogs to determine common dog park-related medical conditions in 2011. Topping off the list are sprains and soft tissue injuries, with lacerations and bite wounds following in second place. My own ER experience supports these statistics, and it wouldn’t be summer in the ER without treating at least a couple of these over the course of a weekend. The remainder of the top list 10 is rounded out as follows: kennel cough, insect bites, head trauma, heat stroke, parasites, and parvovirus.
Each of these conditions can make a fun day at the park a costly one. The most common conditions on the list, sprains and soft tissue injury, carry the price tag of an average of $213 per pet. Insect bites, turn out to be the least expensive, and run an average of $141 per pet. The most expensive medical condition to care for is heat exhaustion or heat stroke, and the reported average cost is $584 per pet. However, if the heat stoke is severe, cost of treatment can easily exceed thousands of dollars.
The majority of medical conditions that occur at the dog park can be avoided by taking necessary precautions, particularly by simply keeping a close eye on your dog at all times. Dog parks have rules just like any other community, and if you follow these tips, it may help prevent an unnecessary trip to your veterinarian or local ER.
Hopefully these tips will make your next visit a walk in the park!
News: Shea Cox
The dos, the don’ts, and the mumbo jumbo myths
July 11 2012
We all love to bask in the California sun and rattlesnakes are no exception. Snakebite envenomation is something that is frequently seen in the ER, in fact, we treated three pets for this just this past weekend alone! Sadie, an 11-week old Cocker Spaniel, was one of those patients. She was gardening with her Mom when a rattlesnake bit her.
Poisonous snakes of the United States belong to two groups: pit vipers and elapids. Pit vipers are the largest group and include at least 26 subspecies of rattlesnakes (Crotalus spp.), with the Western Rattlesnake being the most common in our region. Click this link for an excellent resource guide that includes pictures of the many species of California rattlesnakes.
How does the venom work?
What makes a bad bite worse?
What are the general signs of a snakebite wound?
What to do if a snake bites your pet:
What NOT to do (and the mumbo jumbo myths)
Tips for prevention:
What is the treatment?
Since the onset of clinical signs can be delayed for several hours, all pets that have been bitten by a snake should be hospitalized for at least 12 hours and ideally 24 hours. Although most pets generally need to be supported and monitored, the vast majority (95%) do survive with early and proper treatment.
Antivenom is the only proven treatment against pit viper envenomation, and the earlier it is administered, the more effective its action. The biggest downside to antivenom is cost, and it can range anywhere from $450-$700 per vial. Usually a single vial will control the envenomation but several vials may be necessary, especially in small dogs or cats. Many animals may do “fine” without it, but it does decrease the severity of clinical signs, as well as speed overall recovery with a reduction in complications. Blood work is also recommended to monitor your pet’s platelet count as well as clotting times of the blood. IV fluid support, intensive pain management, antibiotics and wound monitoring are required for best clinical outcomes. Blood and plasma transfusions are sometimes needed in severe envenomation.
What about the vaccine?
Thankfully, most snakes will try to avoid you and your pets and typically only bite as a last resort. But if your pet does happen to get bitten by a snake that you think might be venomous, it is best to err on the side of caution and get medical attention immediately. As always, feel free to ask questions or leave comments!
News: Shea Cox
July 2 2012
One of the busiest times of the year for our emergency service is the Fourth of July holiday. While many people celebrate Independence Day with fireworks and BBQ’s, many others spend it waiting in the ER while their pet is treated for an array of holiday-induced emergencies, including serious laceration injuries from pets jumping through glass windows or doors, high rise fall injuries due to jumping from balconies, hit by car trauma as pets attempt to flee from noises, dietary indiscretions from our pets stealing post-picnic scraps, and cases of severe anxiety due to overwhelming stimulation. In addition to the trauma that we see, we also receive many phone calls from distressed owners trying to locate their lost pet, following it running away from home in a panicked state.
Follow these tips to help prevent injury and loss during this holiday:
It is hoped that these tips will help ensure a happy holiday celebration for your entire 2 and 4-legged family… one without any trips to the animal ER!
News: Shea Cox
June 28 2012
As an ER vet, I officially mark the start of the summer season when I see several patient charts over the course of a 10 hour shift with the presenting complaint: sudden sneezing. By the third one I think, “Another one? What the foxtail!”
Annual grasses releasing foxtails grow quickly throughout the rainy season. As temperatures rise, the foxtail-shaped tip of each grass blade dries out and the individual awns take a ride on any passing object. This plant is engineered by nature to spread its seed, and the foxtail is actually designed to burrow further into an object with each movement, making it a major problem for small animals.
There is no escape. The pesky seeds from these dried grasses get stuck everywhere, and I mean everywhere, our furry friends included. Many pet owners have heard the warnings about foxtails and know to avoid them as much as possible. What many don't know, however, is that foxtail migration can cause severe—and potentially deadly—consequences.
While foxtails are often caught in the fur and can be quickly removed, they can also migrate internally if left unfound through several common routes such as the nose, ears, and eyes. They can even penetrate through the skin or through a pet’s genital openings. If these problematic hitch-hiking seeds find their way inside of a pet’s body, they can cause many serious problems. Once internalized, foxtails can wreak havoc on the body, causing internal abscesses and even infections of the bones around the spinal cord. I have also seen cases of foxtails getting lodged in the abdominal organs or lungs.
While foxtails aren't always easy to spot, their presence can be noticeable through various telltale symptoms, depending on their location in the body. Be mindful of the following symptoms during foxtail season:
If any of these symptoms are noted, you should see your veterinarian immediately for a check-up. If a foxtail is found relatively superficially in the skin or nose, it can be removed rather simply. If a foxtail has moved into the lungs or deeply into the nose or genitals, an endoscope can be used for its location and removal (pictured).
An endoscopy involves the use of a high-tech instrument with a specialized video camera and small grabbing tools that can be passed through the mouth, nose, or rectum and is a lot less invasive than traditional surgical methods. However, if the foxtail has entered the belly or lungs, surgery is sometimes the only treatment possible.
While it's best to avoid areas where foxtails grow, if your pet has been exposed to the grass, make sure to brush her coat well, feel all over the body with your hands, and perform a thorough inspection of the ears, nose, between the toes and paw pads, and underneath the collar after each romp. It’s important to learn about the dangers of this plant, take extra precautions, and remove foxtails immediately. Be overly cautions during foxtail season- dogs and their people deserve to enjoy a drama-free summer outdoors.
News: Shea Cox
When a good chew turns bad to the bone
June 20 2012
An uncanny reason for a visit to the ER is when a playful pup manages to get one of those circular marrow bones caught around its lower jaw and canine teeth. I still remember my first patient that found himself in this very predicament; perplexed, I thought, “How is this even possible?” While it looks like a trick that only David Copperfield should be able to pull off, it can actually happen with surprising ease.
When it comes to marrow mishaps, I have seen the entire breadth of bone bad luck. While some are easily removed with lubrication and gentle manipulation alone, others need to be removed with a cast cutting saw (or other manly tool, depending on the thickness of the bone) while the pet is sedated. I have also seen dogs that have suffered from fractured canine teeth as well as extensive injury to their lower jaw and tongue. Tissue injury occurs when the circulation of blood is cut off to the skin and/or tongue while it is trapped within the bone. The marrow bone literally turns into a tourniquet with the continued and inevitable swelling of the tissues. Major or minor, any of these situations can be painful, distressing, and potentially very costly, depending on the extent of trauma and demeanor of your pet.
Your dog absolutely loves these bones and you love to give them, so what’s a pet parent to do? Here are a few tips to help prevent any misadventures:
As gratifying as these treats can be, one can still find a bone to pick with them because the serious complications happen just as often as the “simple ones.” The marrow of the story: know the risks and let your pet enjoy them only under direct supervision.
News: Shea Cox
June 13 2012
This morning, as I watched my partially bald dog Dharma bask in the sun’s rays, I was reminded of the risks that the sun and heat can pose to our pups. It has prompted me to discuss a few sun tips to help keep our dogs safe- while still having fun- this summer season.
Despite all that fur, it’s important to be aware of the risks of sunburn in your pet. Dogs, especially those with short hair, white fur, and pink skin, can easily sunburn, and this can be just as painful for your dog as it is to us. Limit your dog’s exposure during peak sun hours (between 10 a.m. and 3 p.m.) and apply sunblock to the ears and nose 30 minutes before going outside. Products available to protect dogs from sunburn include vests that block ultraviolet rays and pet-specific sunscreen made with ingredients repellent to dogs to keep them from licking it. If you are unsure that your sunscreen is pet-safe, double check the label to make sure it doesn’t contain zinc oxide (Desitin) or salicylates (aspirin); these can be toxic if licked off and ingested in large amounts. Stomach irritation can also occur if excessive amounts are ingested, so be careful about putting too much on in an area where they can lick it. If your dog has lupus or pemphigus (a condition that results in a crusty appearance to the nose), consult with a dermatologist before putting sunscreen on his or her nose or before letting outside.
While out at the beach, it is imperative to always have a fresh water source available and offer it frequently. If your dog gets thirsty, he may begin to drink the only available water, which is often salt water, and this can lead to toxicity. A few gulps of salt water won’t harm your dog, but watch for vomiting and early neurological signs of salt poisoning such as dullness and depression.
Scan the water and sand for jellyfish. Be aware of sea lice that can cause itchy red bumps on dogs. Salt can be irritating to paws and skin, too. Rinse salt water and sand from your dog’s coat after swimming. Always clean and dry ears after a swim. Water that remains in ears, especially from a dirty lake, can result in a bacterial ear infection.
Running on the sand is strenuous exercise, and this can easily lead to heat stroke. A dog that is out of shape can also easily pull a tendon or ligament, so keep a check on your dog’s activity. Hot sand (and pavement) can blister delicate pads that are new to these hot surfaces.
For dogs who enjoy the sport of boating, just like people, he or she should always wear a life jacket. Make sure that the life jacket fits properly and let your dog get used to having it on while swimming before going deeper into the water.
If you have a breed that is predisposed to eye problems (such as a Pug or Shepherd), you may want to consider Doggles to help protect their precious peepers.
And finally, never, ever leave a dog unattended in your vehicle in the summer months. Heatstroke and death can occur within minutes in warm temperatures and we have already treated several cases of this in our hospital over the past 2 weeks!! You can read further about heatstroke (what and what NOT to do) here.
I hope these tips help keep your pets safe during these upcoming summer months!
Have a doggy sun-proofing idea? Please share!
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