Shea Cox

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

Wellness: Health Care
DIY Physical Exam: An “owner’s manual” for your dog Part 2
Part 2 in 4 part guide

Hello again, Bark readers!  Welcome back for the second installment of the DIY physical exam.  We are going to start at the head today, continuing to move down the dog body over the next couple of weeks. 



  • Smooth, soft and clean; it is a misconception that a dry, warm nose means illness; sometimes a normal nose can appear slightly dry as well as warm to the touch; a healthy nose should feel like soft, supple leather; it is not necessarily always cool, wet and moist.


  • Excessively dry and cracked.
  • Colored nasal discharge; a green, yellow, or white discharge generally indicates a bacterial infection (scant, clear, watery discharge can be normal) .
  • Bleeding



  • Bright, moist, and clear.
  • Centered between the eyelid.
  • Pupils are equal in size.
  • Whites of the eye should not appear colored (such as red or yellow) and should have only a few visible blood vessels.
  • Pupils should shrink equally when a bright light is shined into either eye and enlarge equally when the eyes are held closed or the room darkened (this is known as a pupillary light reflex and is part of a neurological exam).


  • Dull, sunken eyes: this can indicate severe dehydration.
  • Eyes that appear dry and “bloodshot” can indicate conditions such as uveitis, KCS (“dry eye”), severe dehydration, or other systemic illnesses.
  • Thick discharge from eyes: a little grey “eye booger” in the morning is normal, just like in us people, but be concerned if you notice any discharge with green or yellow color to it.
  • One or both eyes not centered: this can indicate a tumor or infection behind the eye, as well as other pathology.
  • Pupils unequal in size: this can indicate head trauma, a possible tumor, other neurologic problems to name a few.
  • Squinting or tearing of the eyes: this can indicate an ulcer or scratch on the cornea, which is the layer of cells covering the eye.
  • Abnormal colors that indicate problems are yellow (jaundice), or red (bloodshot); pay close attention to the color of the whites of your pet’s eyes.
  • The appearance of blood in the eye (known as hyphema): this can indicate exposure to rat bait or other causes of your pet’s blood not being able to properly clot.
  • Pupils fail to respond, or respond differently from one another, when a bright light is shined into either eye.


Chronic ear problems are common in pets, and are often a result of allergies to inhaled pollen (like hay fever in people) that are then complicated by secondary infections with bacteria or yeast. Ear infections can be painful and head shaking can lead to an accumulation of blood in the floppy part of the ear, known as an aural hematoma.


  • Skin smooth and without wounds.
  • Clean and dry.
  • Almost odor-free.
  • Typical carriage for breed.
  • Pain-free when you massage them, especially at the base of the ear.


  • Wounds, scabs, or any sign of rash.
  • Crust, moisture, or other discharge in ear canal.
  • Any strong odor.
  • Atypical carriage for breed; for example, a droopy ear in a breed with normally erect ears
  • Painful or swollen ears.



  • Teeth are clean and white.
  • Gums are uniformly pink and moist to the touch (they should not feel dry or sticky).
  • Capillary refill time (CRT): to assess, press on the gum tissue with your finger or thumb and then release quickly; the part you just pushed on will turn white, and you will then watch the color return to the gums; this is a crude assessment of how well the heart and circulatory system are working as well as hydration status of you pet; a normal CRT is 1 to 1.5 seconds for the color to return; this can be a difficult test to interpret sometimes (for example, if your pet has dark or pigmented gums), and should not be relied upon as definitive evidence that your pet is sick or healthy.


  • Tartar accumulation around the base of the teeth.
  • The gums are red: this can indicate severe dehydration, shock, heat stroke, or sepsis (severe infection in the body).
  • Gums are bluish or purple: this indicates inadequate oxygen to the body; this can be noted with lung disease, heart disease, or any disease that impairs proper oxygen to the body.
  • Gums are pale: this is due to lack of blood or shock and possible causes are internal bleeding (such as a mass on a spleen that suddenly ruptures and bleeds- very common in older dogs), trauma or shock (such as when a dog has been hit by a car), and immune mediated diseases.
  • Gums that appear to have little bruises: this is known as petechiation and is generally seen with rat bait toxicity or other problems with the body’s ability to clot the blood
  • Gums are inflamed, “spongy” looking, or sore in appearance.
  • A sluggish CRT, or dry and sticky gums.


That completes the head!  Please feel free to ask any questions and see you next week as we discuss and learn about the chest area, known as the thorax. Check out DIY Physical Exam: Part 1 of this series if you missed it. Next, DIY Physical Exam: Part 3.


Wellness: Health Care
DIY Physical Exam: An “owner’s manual” for your dog Part 1
Part 1 in a 4 Part Guide
Dog Exam - DIY Dog Physical Exam at Home

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.


  • A normal temperature is between 100 F and 102.5F
  • The thermometer is almost clean when removed


  • Temperature is below 99 F or above 102.5 F
  • There is evidence of blood, diarrhea, or black, tarry stool on the thermometer; black/tarry stool can indicate a bleeding ulcer in the stomach or small intestines, or point to other sources of disease


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.


  • Dogs: 60 to 160 beats per minute (bpm): relaxed, large breed, or athletic dogs tend to have slower heart rates, while small breed dogs and puppies tend to have higher heart rates. This marked variability in heart rate stresses the importance of knowing what is normal for your pet.
  • The pulse should be easily felt and the quality of it should be strong and regular



  • Too rapid or too slow
  • Pulse is weak, irregular, or hard to locate


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.

Wellness: Health Care
Ick! It’s a Tick on My Dog!
The top 5 tick myths dispelled

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!


Wellness: Health Care
Prescriptions for Pet Meds
Making the cost of pet care easier to swallow

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;
• Requires veterinarians to write a prescription regardless of whether or not the hospital will dispense the medication;
• Verify a veterinary prescription electronically or by other means;
• Prohibits a veterinarian from requiring payment for providing a copy of or verifying a prescription;
• Requires a client to sign a waiver or liability disclaimer should the veterinary prescription be inaccurately filled by an off-site pharmacy;
• Supply a client with a notice waiving or disclaiming a veterinarian’s liability for the accuracy of the veterinary prescriptions filled off-site.

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?”

Dog's Life: Lifestyle
Keep your Lawn Free from Urine Spots
Dilution is the solution to pollution

 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!





Wellness: Health Care
It’s Not Always “Just A Walk in the Park”
The most common dog-park related incidents revealed


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.

  • Obey all posted rules and regulations at the park; I cannot tell you how many times I’ve treated scuffles between dogs at a “leashed park,” where one owner obeyed the rules, and the other had their dog free roaming, leading to trouble.
  • Pay attention to your pet at all times, and just as importantly, pay attention to other pets, too. Be in tune to the body language given off of your dog as well as all interactions between your pet and its playmate of the moment.
  • Do not bring a puppy younger than 4 months of age to the park.
  • Make sure your dog is up to date on all of its vaccines and has a valid pet license; if your dog does happen to get into a fight, and your pet is not properly licensed, another level of predicaments can follow with animal control.
  • Keep an identification collar on your dog and make sure your pet’s microchip information is up to date.
  • On very warm days, avoid the park during peak temperature hours, typically between 10 a.m. and 4 p.m.
  • Look for signs of overheating that include profuse and rapid panting, a bright red tongue, thick drooling and saliva, lack of coordination, collapse or disorientation. If this occurs, bring your pet into a veterinarian IMMEDIATELY while instituting cooling measures.

Hopefully these tips will make your next visit a walk in the park!



Wellness: Health Care
Rattlesnake Bites the Dog
The dos, the don’ts, and the mumbo jumbo myths

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?
An understanding of the function of venom is helpful in appreciating how envenomation works. The snake uses its venom to immobilize the victim and predigest body tissues. There are over 50 types of enzymes in pit viper venom, with a minimum of 10 in any individual snakes venom.  Additionally, there are many other non-enzymes present in the venom, called killing fractions, which are 50 times more toxic than the “crude” venom. When the venom destroys the body tissues, it is possible for up to 1/3 of a pet’s body fluid to be lost into the tissue spaces within several hours, which can result in life-threatening drops in blood pressure resulting in shock.

What makes a bad bite worse?
Several factors influence the severity of snakebites. The most important factors are the volume of venom injected and the toxicity of the venom itself. Other factors include:

  • The amount of regenerated venom since the last bite: there is more venom and it is more concentrate if the snake hasn’t bitten in a while.
  • The age of the snake: younger snakes have more “potent” venom.
  • Aggressiveness of the snake: the more threatened they feel, the more concentrated the venom.
  • Motivation of the snake: offensive strikes are more severe.
  • The size of the pet being bitten: smaller dogs and cats are more severely affected than large dogs due to their small body size to venom ratio (less body to “absorb” the amount of venom).
  • The size of the bite.
  • The location of the bite: the “best” place to be bitten is in the legs or face as the regional swelling and changes in the local blood supply can actually slow the uptake of the venom; envenomation to the body is more concerning as the broader area allows for the venom to be absorbed more rapidly; bites to the tongue are the worst and result in rapid and devastating clinical signs.
  • The time elapsed from bite until seeking medical treatment.
  • The amount of physical activity since the time of the bite.

What are the general signs of a snakebite wound?
Snakebites are not always easy to diagnose, especially if it was an unobserved bite and if a pet has a heavy hair coat that may hide puncture wounds. With pit viper bites, you can usually see bleeding puncture wounds and single or multiple puncture sites may be observed. The initial signs are marked swelling, which is due to the tissue destruction and body fluid “leaking” into the damaged area (see the picture of the little Chihuahua, showing a what a typical bite to the face looks like). Clinical signs may develop immediately or be delayed for several hours. Bruising and skin discoloration often occurs within hours of the bite because the venom causes the blood to not clot. There is usually intense and immediate pain at the site of the bite, which helps differentiate snakebites from other causes of swelling, and swelling is generally progressive for up to 36 hours. You can also see collapse, vomiting, muscle tremors, and depression in breathing.

What to do if a snake bites your pet:

  • If your pet is bitten by a snake, it is best to assume it is a venomous bite.
  • Seek veterinary attention as soon as possible!
  • If the swelling is not in the face, muzzle your pet (if you can do it safely) to avoid being bitten: snake bites are very painful and your pet may unintentionally snap at you; if the swelling is in the face, avoid touching this area all together.
  • Immobilize the part of your pet that has been bitten by the snake, if this can be done safely; try to keep the area at or below the level of the heart.
  • Keep your pet calm and immobile, carry if necessary.

What NOT to do (and the mumbo jumbo myths)

  • Do not try to suck out the venom! (This technique only works for John Wayne in old Western movies).
  • Do not attempt to “make an X” and cut open the area around the bite (you will only cause a wound).
  • Do not bother to use a Snake Bite Kit or Extractor Pump (they will actually do more harm to your pet- and your wallet!).
  • Do not apply ice to the area: this constricts the blood vessels locally and actually concentrates the venom causing severe muscle damage to the area.
  • Do not rub any substances into the bite: the venom has entered the blood stream, and any substance applied topically is ineffectual.
  • Do not apply a tourniquet: you will only succeed in causing further tissue damage and possibly create a need for limb amputation.
  • Do not allow your pet to move about freely.
  • Do not attempt to capture the snake for later identification (you’d be surprised…)

Tips for prevention:

  • Stay on open paths while hiking with your pet.
  • Keep your pets on leash away from high grass and rocky outcrops where snakes like to rest.
  • Don’t let your pet explore holes or dig under rocks.
  • Keep an open ear for that telltale rattling noise and keep your pet at your side until you determine where the sound is coming from, and then move slowly away.
  • If you see a snake that sees you, remember that a snake can strike only a distance of half its body length; give the snake time to “just go away” as they are not looking to interact with you or your pet.
  • Don’t let your pet examine a dead snake as they still can envenomate.
  • For around your home: cut off the snakes food supply and shelter by mowing close to the house, storing firewood away from the house, plugging up holes in the ground, and limiting birdseed waste which can attract rodents to your home.

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?
There is a “snake-bite vaccine” that may be useful, but there have been no controlled studies for its effectiveness. The main benefit of the vaccine is that it may create protective antibodies to neutralize some of the injected venom, and in turn may lessen the severity of the clinical signs. One of the biggest myths is that if your pet has had the vaccine, then they don’t need to be treated if they are bitten; this is not true, and they still require the same treatment despite being given a vaccine or not!

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!

Dog's Life: Lifestyle
Safety Tips for Dogs on the 4th of July

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:

  • Make sure your pets are secured indoors and as far away from the sounds as possible as the loud noise of fireworks can startle. Keep your pet in a safe room where they are comfortable once the festivities begin. If your dog is crate trained, put him/her in its crate with a blanket to help offer a feeling of security. You can also help to block the outside sights and sounds by lowering the blinds and turning on the television or radio. And remember, it is a mistake to assume that a fenced pet won’t look for a way to escape the yard during times of extreme stress!
  • Be sure that your animal can be identified in case they do escape! If you don’t already have a name tag for your dog, instant ones can be made “on demand” at many local pet supply stores. Engraved tags start at $5.99. Microchipping your pet is one other way to help missing animals find their way back home. Sadly, many animals that have been microchipped are not registered in the system and we are unable to reunite families; please ensure that your pets microchip truly has been registered, and just as important, that your address and phone numbers are current!  If you are in question as to whether your pets microchip is active, see your veterinarian for a scan prior to the holiday!
  • If you live out of earshot of city fireworks displays, don’t forget that small neighborhood displays or children can be just as distressing to your pets; if you or your neighbors plan to celebrate, it is still important to keep a sharp eye on your well-secured pet; if you plan to go to a friends home for the festivities, it is safer to keep your dog home than to bring him or her, even if the party is dog-friendly. If you have to leave for the day, keep your pets inside of the house rather than outdoors to help remove the temptation to leap over the fence to try and find you.
  • Pets often try to relieve anxiety by chewing and it is important to make sure confined pets do not have access to anything that they could destroy. Indoor crating could be a good option for some dogs, but not for periods longer than four hours, and you still need to keep a watchful eye on them while contained. We have seen injuries as mild as broken toe nails from trying to “dig out” from their kennels, to more extreme cases of mouth trauma and fractured teeth. This is not a good option to try if your pet has never been crated before as this will only add to their distress.
  • You can also distract your four-pawed friend with a toy and praise him or her for non-fearful behavior, like tail-wagging.
  • Some pets respond well to sedatives, such as Acepromazine. It is always a good idea to plan ahead and anticipate that this will be a time of stress; make an appointment with your veterinarian to have your pet examined and a sedative dispensed, or, if your pet has had a physical exam in the past year by your veterinarian, they will often dispense this medication for you if your pet is otherwise healthy. There are also herbal over-the-counter remedies such as Feliway and NaturVet Calming Aid, which can offer homeopathic relaxing effects to your pets. Thundershirts can also be very helpful for some pets at reducing anxiety caused by noise.
  • Do not feed your dog scraps from the grill and properly put away those garbage bags filled with the remains of your Fourth of July picnic—the lure of leftover BBQ chicken, corn cobs and the like is often too great for any pup to resist, and these types of dietary indiscretions can lead to pancreatitis, gastroenteritis, and intestinal foreign bodies requiring surgical removal. Remember that some foods can be toxic to dogs such as chocolate, onions, grapes, and avocados. Alcoholic beverages also have the potential to poison our pets.
  • Avoid spraying your dog with insect repellant and only use sunscreen that is intended for animal use as human products can be dangerous to your pets. Ingestion of sunscreen products can result in drooling, vomiting, diarrhea, excessive thirst and lethargy. The misuse of insect repellent that contains DEET can lead to neurological problems. Always keep matches and lighter fluid out of your pets’ reach; certain types of matches contain chlorates that can damage blood cells and result in difficulty breathing or kidney disease in severe cases. Lighter fluid can be irritating to the skin and if ingested, can produce irritation of the stomach and intestines as well as causing aspiration pneumonia if it is inhaled or vomited.  Citronella candles, insect coils and oil-based insect repellents can also cause stomach irritation and possibly central nervous system depression.

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!

Wellness: Health Care
Foxtails Can Pose Serious Risks to Dogs

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:

  • Nose: violently sneezing and pawing at the nose, and sometimes a bloody nose.
  • Eyes: rubbing the eye, squinting and pain, excessive tearing or discharge, or an eye “glued shut.”
  • Ears: head tilt or violent shaking of the head from side to side, pain, discharge, or odor.
  • Mouth/Throat: gagging, loud coughing, difficulty swallowing (you will notice your pet having “exaggerated swallowing” movements, like when you have a sore throat), and possibly increased odor.
  • Paws: continuous licking of the paw or pad, or the appearance of a swollen “bubble” between the toes, or a small “hole” in the skin which is indicative of a draining tract, which is the path the foxtail is taking under the skin (pictured)
  • Under skin: formation of sores or abscesses.

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.


Wellness: Health Care
Bone Marrow Mishaps
When a good chew turns bad to the bone
Dog with bone stuck around lower jaw

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:

  • Size really does matter. Make sure the size of the marrow bone is suitable for the size of your pet. Have your butcher “custom make” your marrow bones, trimming them into longer pieces, such as 8 inches for larger dogs. Skinnier bones can more easily work themselves around the jaw, and should be avoided.
  • Try a knuckle bone instead. These can offer a similar chewing experience, and because there’s no hole, there is no risk of it slipping around the jaw. However, as with any type of bone, these too, can come with risks. Be sure to take them away while they are still large, which is as soon as the gristle and soft parts of the “knuckle knobs” are gone. This will help to prevent accidental swallowing and choking once it is whittled down to a smaller size.
  • Sensitive stomach? Marrow bones may not be the chew of choice for those pets that get diarrhea or an upset stomach easily.  Marrow is very high in fat, and I have seen them cause these signs, as well as pancreatitis, in pets that are not used to the richness of the marrow fat.
  • Lastly, never leave your dog unattended while he or she is fancying the flavor—it is amazing how fast these accidents happen! And remember, extra aggressive chewers need extra close supervision.
  • 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.