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
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.
Dog's Life: Lifestyle
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!
Dog's Life: Lifestyle
Plant and its seeds are toxic to pets
May 30 2012
One of the highlights of my weekend was the successful treatment of an adorable puppy named Leeloo. After being hospitalized for nearly 72 hours, she thankfully fell into the percentage of dogs who survive the ingestion of this highly toxic plant: the sago palm.
Sago palms are not really palms at all; they just look like one. The sago palm is a cycad and contains the toxin cycasin and even very young plants are toxic enough to cause death in pets. Contrary to popular belief, all parts of both male and female plants are toxic, with the seeds being the most lethal component.
The reddish-orange seeds are round to oblong in shape and can be a little bigger than a golf ball in mature plants. Many dogs seem to enjoy chewing on these bitter seeds, which leads to nothing but trouble. I’ve even heard talk of people throwing the seeds like a ball for their dog, completely unaware of the deadly dangers!
Like Leeloo’s family, many people are unaware that the plant is deadly. And even if they have heard of the toxic effects, they don’t realize that the plant they are purchasing is actually a sago palm! Why is this? The plants are becoming increasingly popular in all areas of the country, and are often sold as unmarked potted plants in stores such as Target and Home Depot. They are simply labeled as a “palm tree,” without any warning label, and people are not aware that they are bringing home a potentially lethal plant. Over the past five years, the ASPCA Animal Poison Control Center has seen an increase in sago palm toxicities by 200 percent, and according to their data, 50 to 75 percent of cases result in the death of the pet. This number includes pets that are euthanized due to the cost of care; on a slightly brighter note, 68 percent of those pets that are treated early are reported to survive.
Dogs who have ingested any part of the plant soon begin vomiting, and this can be accompanied by diarrhea, depression, and lack of appetite. Liver failure generally occurs within 24-36 hours following ingestion, and in most cases, intensive treatment is necessary. If it has been 4-6 hours since ingestion, your veterinarian will attempt to induce vomiting, as well as give charcoal to help absorb the toxin. Intravenous fluids for 72 hours, medications to help support liver function, and possibly the transfusion of blood products are needed. Frequent monitoring of liver values will help to determine if your pet will survive the exposure.
Leeloo was a lucky survivor and we were able to keep her from going into liver failure with early and intensive treatment. Sadly, there was a case a couple of months ago that involved one of our police dogs, and he did not survive. The officer had a sago palm in his yard for 5 years, unknowing of the danger, and his canine partner decided to chew on a seed after leaving it alone all that time. So please, if you share your home or yard with a sago palm, now is the time to dig it up and dump it in the garbage. Make sure you are disposing of it in your “actual” garbage, and not your compost or yard waste bin, as these contents are often mulched and repurposed, putting the palm back into the environment where other pets can be exposed. If you believe that a pet may have eaten any part of a sago palm, please seek veterinary care immediately!
Wellness: Health Care
Awareness and prevention of “shake and bake” toxicity
May 21 2012
Spring is one of my absolute favorite times of the year. The arrival of new bulbs and blossoms breaking through the earth makes me giddy. It’s the official kick-off of another season in the garden and I look forward to the earth’s welcoming party. But spring also brings snails, followed close behind by the perennial gardening-season danger, snail bait.
Gardeners around the country use snail bait to keep plant-munching slugs and their ilk out of gardens, and it constitutes the most common poisoning agent in my community. Unfortunately, it’s extremely toxic when ingested by pets. During the spring and summer months, I treat pets poisoned by snail bait at least once a week.
The toxic substance found in snail bait is a compound called metaldehyde. Malicious poisoning is generally not the issue. The majority of toxicities are accidental, either due to lack of knowledge of its dangers or thinking that the compound has been properly stored or applied: Dogs are notorious for getting into things they shouldn’t or into places you think they can’t!
Snail bait is formulated in chewable pellets that are flavored with molasses, apple and bran to attract the snails. Unfortunately, our dogs find this a tasty treat as well. Snail bait is also available in liquid and powder formulations, which can get onto paws and be licked off with normal grooming. Additionally, many of these products also contain insecticides, which make the exposure potentially even more toxic.
Snail bait is highly toxic and even small amounts are enough to cause poisoning: less than a teaspoon per 10 pounds of body weight can cause life-threatening clinical signs in your pet.
What are the symptoms of snail bait poisoning?
Severe twitching equates to constant muscle contractions, and this can raise the body temperature so high that permanent brain damage can result. This clinical course has lead to the colloquial emergency room term of “shake and bake syndrome.” Click the link to watch a short video that demonstrates what mild clinical signs of snail bait toxicity look like.
Making the diagnosis
What is the treatment?
At home, your yard should be hosed down with water to dissolve any remaining bait and your dog should be restricted from the area for a two-week period.
Will my dog return to normal following toxicity?
I love my dog, but I also love my beautiful garden—what are alternative ways to keep snails at bay?
Wrapping self-adhesive copper barrier tape (available in many garden supply stores) around the rim of plant pots or containers deters slugs and snails with a tiny positive electric charge that is given off by the tape.
One of my favorite alternatives is to purchase predatory snails known as Decollate snails. These snails do not pose a health hazard to pets, birds or other mammals and they have been used in gardens and landscapes throughout the temperate regions of the United States for nearly 150 years. This famous predator snail comes out of the leaf mulch or soil at night and eats the eggs of slugs and snails as well as feeding on the young snails. The Decollate Snail can live for two years and lays a small amount of eggs on a regular basis so there should always be many new protectors in your garden.
You can also purchase various commercial snail traps. There are also many “home-made” snail traps options as well. For more information, watch this video demonstration of how to control slugs organically, helping to protect your garden without fear of harming your pets.
As always, prevention is better than cure and hopefully this article has raised your awareness of the dangers of snail bait. If an accident does happen, it is critical to seek veterinary attention immediately. If you suspect snail bait ingestion, please go directly to your veterinarian immediately as every minute counts!
Wellness: Health Care
Vestibular signs in dogs are often incorrectly referred to as a stroke
April 25 2012
A fairly common reason for a veterinary visit is the concern that an older dog has had a stroke, when he suddenly starts walking like a drunken sailor with his head tilted. I know of other cases, where these sorts of symptoms are assumed to be a brain tumor and the dog is euthanized—maybe unnecessarily. (The condition plays a role in the new Hallmark movie, Duke.)
Well, I want to shed some light on a much more common and less concerning cause of these and other disturbing signs, something known as idiopathic vestibular disease, in case it is something you ever experience with your own geriatric dog.
Idiopathic (meaning unknown cause, think: idiot) vestibular disease is a syndrome that looks really, really bad, but usually gets better all on its own with little or no treatment.
The vestibular system
These videos show a dog with mild, but very typical, vestibular signs and another dog with more severe signs.
Now for the caveat: These clinical signs are unfortunately not unique, or diagnostic for, idiopathic vestibular disease and other things can cause this same presentation. These can include (yes) a brain tumor, an inner ear infection, inflammatory disease or sudden bleeds into the brain—to name a few. But with that being said, when the symptoms seemingly appear out of nowhere in an older dog, I always recommend a “wait-and-see approach,” treating symptomatically and supportively, as there is a good chance of improvement.
I examine both ear canals, and if an infection is suspected, I discuss antibiotic therapy, as inner ear disease is one of the possible causes of vestibular signs. The inner ear (pictured below) is something you cannot see during an exam because the eardrum obscures the view to the inner ear. The eardrum is like a closed door that sits in front of the middle and inner ear. However, if there is a nasty looking outer ear and an inflamed eardrum, there is a chance that inner ear disease could be present as well.
If the dog’s clinical signs are so severe that they cannot walk, I then recommend supportive care with IV fluids and injectable anti-nausea medications. Urinary catheters are sometimes placed for hygienic reasons. If clinical signs are mild, pets can often be managed at home with over-the-counter meclizine (for the feelings of “motion sickness” they experience). We also provide instructions for general nursing care as well as how to protect from falls.
The conversation ends with discussing a very loose rule of thumb: If there is gradual or complete improvement within 72 hours, it is likely idiopathic vestibular disease and additional diagnostic testing is not necessary. If there is no improvement or progression of signs, it is likely something much more serious, such as a tumor, and an MRI would be recommended to reach a definitive diagnosis. With idiopathic vestibular disease, marked improvement is usually evident in this time frame, with the pet returning to normal in 7 to 14 days (although in some dogs, a head tilt will still persist).
It should also be noted that this is not a painful condition, and my recommendations stem from the fact that euthanasia is a permanent decision, so why not wait and see, giving time a chance? There is a high likelihood that improvement will be seen and the difficult decision of euthanasia can always be made at a later date if there is no improvement or if there is a change in your pet’s quality of life. I feel there is reason to hold out hope and be cautiously optimistic, as idiopathic vestibular disease is the most common form of vestibular disease in dogs. It is the direction I would take if it were my own boy experiencing this.
Please note: There are times, however, when a physical exam points undeniably to a brain tumor, but these neurological exam findings are beyond the scope of discussion, so feel free to ask me any questions.
Dog's Life: Lifestyle
The lengths we can go to preserve our precious pups
April 18 2012
Following a recent euthanasia, the owner asked me to collect some of his Labrador’s fur. I was under the assumption that he wanted a tangible fragment to remember his dog by, but when I handed him a locket of fur, he told me that he was going to “look into cloning him.” He asked me if fur was enough and if I knew of any cloning resources. I was at a loss. I realize these questions were, in part, triggered by his grief, but it got me thinking about how far people go to hold on to their best friends.
Genetic cloning became popular back in 1996, when scientists were able to duplicate a sheep named Dolly. Today, this high-tech genetic engineering is becoming more accessible—for those with a spare $100,000 lying around.
Currently, the procedure is available at the Sooam Biotech Research Foundation in South Korea. The process involves collecting fresh eggs from the egg donor, removing the original nucleus and replacing it with the cell of the deceased animal. This “piece” of the original, living pet is injected into the egg, fused together, and then transferred into a surrogate mother. After the normal 63-day gestation period, two identical animals are born.
Some of the controversy arises from current overpopulation of pets and the fact that so many living in shelters need to find homes or face euthanasia. Not to mention the fact that the money it takes to clone a deceased animal could go very far to help those still living.
Another controversy stems from the fact that studies have shown that despite “identical” cloning, you are not going to end up with the same exact dog that you had before; it may “look” identical, but may not behave identically.
All that being said, however, should one judge or deny another the joy of a second life with a best friend that has meant everything and more to him or her? What if it is a therapy dog, who is a cornerstone and foundation for a dependent person? Just thinking …
Well, if cloning is not your gig, there’s yet another option for preserving your pet: mummification. Believe it or not, more than 1,500 people across the world have contacted a business called Summum, which says it’s the world’s only mummification company. The Salt Lake City, Utah-company claims a clientele from around the world, including celebrities as well as us “common folk.”
Summum’s mummification process takes three months, and begins with the removal and cleansing of the organs, which are placed back inside the body, followed by hydration of the body by submersion in a tank for more than 70 days. The body is then covered with lanolin and wax, followed by layers of cotton gauze and a fiberglass finish. Lastly, the body is encased in a steel or bronze animal-shaped casket.
The body of your pet will still look like the day it died—even thousands of years later. This process is a little more affordable than cloning, at just under $24,000 for canine companions. And, to return to where we started, Summum says mummification has tremendous implications for cloning, as it is feasible to later remove DNA by drilling into the casket.
Would you ever consider cloning or mummifying your four-legged best friend?
Wellness: Health Care
Monthly flea prevention warning for homes with dogs and cats
April 11 2012
Bayer makes two different flea control products that can easily be confused with one another, leading to potentially lethal complications in our feline family members. Advantage has formulations approved for both dogs and cats, while the product Advantix is intended for use in dogs only. Advantix causes permethrin toxicity in cats, which is a common emergency I see, especially during the spring and summer months, when fleas are at their peak of peskiness.
What exactly is the difference?
Advantix is also a topical solution for the treatment and prevention of fleas, ticks, biting flies, mosquitoes and lice on dogs. The product’s active ingredients are imidacloprid and permethrin. It is the addition of permethrin to the recipe that makes the deadly difference.
Dogs can metabolize permethrin effectively, resulting in a safe product for them. However, cats cannot metabolize this ingredient, and will suffer from toxic effects if exposed. Cats are exposed to Advantix in a variety of ways, including direct application, close contact with a dog who has been treated within 48 hours, or if they have groomed a doggy pal’s fur after an application.
What are the symptoms?
What is the treatment?
Prognosis for recovery is excellent with early treatment.
If you do use canine Advantix in a home with cats, apply the medicine to your dog while your cat does not have access to the area or to the dog and allow for the medicine to fully absorb into your dog’s skin—when you can no longer visibly see the oily medication on the fur—before allowing your cat back into the same room. I have treated cats that were obsessive groomers and decided the fur between “their” dog’s shoulder blades needed to be cleaned.
And lastly, always double-check labels and read all the fine print; you can even have someone just “double-check you” as another safety precaution.
Wellness: Health Care
April 4 2012
Working in the ER, I often see dogs suffering from blood loss as a result of trauma, which can become life-threatening if not properly treated. If bleeding is severe or continuous, a dog can lose enough blood to cause shock.
Shock from blood loss is classified as hypovolemic shock, which basically means that there is not enough fluid (blood) circulating throughout the body. Without an adequate volume, organs such as the kidneys and GI tract are not being perfused (nourished), and this state can quickly turn deadly. Your veterinarian can tell if your dog is in shock by physical exam findings such as a high heart rate, a low blood pressure and weak pulses.
Did you know the loss of as little as 2 teaspoons of blood per pound of body weight can result in shock? This blog post describes ways to control bleeding in your pet during transport to your nearest veterinary hospital.
The following techniques are listed in order of preference. As a word of caution: The first rule when dealing with an injured pet is to avoid injury to yourself. Take appropriate precautions, such as the use of a muzzle, to avoid being bitten. You can create a “make-shift muzzle” by using a long piece of material such as a men’s tie, non-retractable leash or piece of cloth. All too often, I see owners having to make a trip to the emergency room for themselves as well as their pet.
The best way to learn these techniques is in a pet first aid class. April is Pet First Aid Awareness Month, a perfect opportunity to sign up for pet first aid classes, which are offered by local chapters of the American Red Cross, some shelters and humane organizations. Also, it's a good reminder to have a complete pet first aid kit (which includes a muzzle) among your dog supplies.
If blood soaks through, do not remove the pad. This will disrupt the clot; simply add additional layers of cloth and continue the direct pressure more evenly. The compress can be bound in place using loosely applied bandage material, which frees your hands for other emergency actions. If you don’t have a compress, you can apply pressure with a bare hand or finger.
Elevation uses the force of gravity to help reduce blood pressure in the injured area, slowing the bleeding. Elevation is most effective in larger animals with longer limbs because of the greater distance from the wound to the heart.
Applying pressure on the supplying artery
Use a 2-inch wide piece of cloth or leash, and wrap it around the limb twice and tie it into a knot. Then tie a short stick or similar object into the knot as well. Twist the stick to tighten the tourniquet until the bleeding stops. Secure the stick in place with another piece of cloth and write down the time it was applied. Every 20 minutes loosen the tourniquet for 15 to 20 seconds. This is potentially dangerous and can result in the need to amputate the limb. Remember, a tourniquet should only be used as a last-resort, life-saving measure.
Internal bleeding can often be more dangerous because it occurs inside the body, and being less obvious, delays evaluation by your veterinarian. There are, however, some external signs of internal bleeding, which can include any of the following:
If your pet is bleeding externally, or you suspect any internal bleeding, immediately transport your pet to your veterinarian or to your closest emergency hospital for treatment. I hope you never have to use the information in the blog, but I feel it is important for everyone with a pet to know.
Wellness: Health Care
Giardia, not muddy paws
March 28 2012
Diarrhea. Boy, do I see lots of this, and when I say “lots,” I mean lots. In fact, on some shifts, it feels like that’s all I see. One of the common causes of diarrhea in dogs worldwide is giardia, a ubiquitous single-celled protozoan parasite. Giardiasis is transmitted by a fecal-oral route, meaning that the parasite is swallowed in food and water (think: puddles, lakes and streams) contaminated with feces. Note: Your pet does not have to eat feces to get the parasite!
Infection can be present without symptoms, but when signs are present, the most common one we see is large volumes of watery feces, oftentimes with blood and mucus. Weight loss, decreased appetite and vomiting can occur as well.
How is the diagnosis made?
How does one treat this parasite?
Giardiasis is generally treated with an inexpensive antibiotic called Metronidazole (Flagyl) that is readily available. In small puppies, such as Rascal, or dogs sensitive to this antibiotic, a dewormer known as Panacur can be used instead for five to ten days.
How do I prevent it?
Dog park puddles carry a higher risk than, say, fresh rainwater pooled in a birdbath or fountain. Remember, giardia is transmitted by a fecal-oral route, and what better place to have concentrated levels of feces than a dog park, especially when some pet parents are not diligent about removing their doggy’s waste. Think of it this way: If a dog infected with giardia defecates on the grass, and the rain creates a puddle of water in grass, your dog is essentially drinking a giardia martini.
It may also be advisable to treat other animals in the same household while treating the infected, symptomatic pet. There is a vaccine available for giardia in dogs, but most veterinarians don’t recommend it unless your dog is at really high risk or is one of those pets who gets giardiasis frequently.
Don’t forget: People can get giardia too. Younger children are at a higher risk as hands often find their way to mouths during outside playtime (grass can be contaminated with giardia cysts as well). And those adorable doggy kisses we love so much? Let’s just say that it is easier to accidentally ingest one of those little cysts than you might think.
There are also environmental control measures that can be taken to prevent reinfection. People should be vigilant in clearing fecal material from the environment. If your pet has been diagnosed with giardia, it is often recommended that you wash as many areas of your environment as possible, followed by disinfection with a solution of bleach diluted in water (another measure that is easier said than done).
As with anything medical, there is no one clinical sign that equals a definitive disease, and diarrhea happens to be of the most common clinical signs of any disease process. Because of this, if your pet has diarrhea that persists beyond 24 hours, or is very sudden and severe, a veterinary exam is in order.
And, on that note, I’ll leave you with this closing mantra: No drinka da puddle, no snout in da bay. Pick up poop in da yard, quickly throw it away!
Wellness: Health Care
Bad breath may not be a sign of dental disease
March 21 2012
Halitosis is the fancy word for bad breath, and that odor is nearly always a sign of a bigger problem. Just this week, I noted a slightly foul odor coming from my own little girl, Dharma. On closer inspection, I noted that the very top of her canine tooth is beginning to turn brown. Overall, the tooth and gumline appear pretty much normal, but I am suspicious of a tooth root infection lurking below.
As in Dharma’s case, the cause of halitosis is most often attributed to dental disease, but there are many other sources of odor that should be considered and put on your mental checklist. These can include:
Diseases of the mouth, in addition infection of gums and teeth, your “basic” dental disease:
Halitosis is a diagnosis that is easily made: Just smelling your dog’s breath at home is the first step. If there is a disagreeable odor, halitosis is present, and there’s a problem. As the list above illustrates, a full spectrum of potential sources of “yuck mouth” exist, and interestingly, as varied as these potential causes can be, sometimes the first clinical sign observed in many of them is odor.
If the diagnosis is not obvious from a peek in the mouth (such as a bad tooth), further steps will be needed check for other disease. Once the reason of the bad breath is discovered, therapy can then be directed at correcting the cause.
The major take-away message is that halitosis is not a disease in of itself, but a sign of disease. While bad breath generally indicates an unhealthy mouth, there are many other potential causes to consider, and evaluation of this symptom by your veterinarian is recommended.
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