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
Great for handicrafts, terrible for dogs
October 12 2011
We all have one—that bottomless black hole known as the “catch all” drawer, and it is not uncommon to find a bottle of Gorilla Glue tucked away in this vortex of odds and ends. People who do a lot of handiwork or crafts love this stuff, but unfortunately, so do our dogs; they find it to be a sweet, appetizing treat.
Why is it bad?
Gorilla Glue and Elmer’s ProBond are popular polyurethane-based adhesives that when ingested can cause serious problems, including death, if not properly diagnosed and treated. While classified as ‘nontoxic,’ these glues contain a catalyzing agent called Diphenylmethane Diisocyanate (MDI). When MDI-based adhesives come in contact with water they expand rapidly and create a hard foam material. The rate of this reaction is enhanced in warm and acidic environments, such as the stomach, and ingestion most commonly results in an obstruction. The reaction also produces heat, which can result in secondary complications such as thermal burns to the esophagus and stomach, which can also be life threatening.
What are the signs of ingestion?
Animals who have ingested these adhesives may present with a variety of nonspecific clinical signs including loss of appetite, restlessness, difficulty breathing, vomiting or a change in behavior. Signs generally develop within 15 minutes, but can occur up to 20 hours following ingestion.
What should I do if my pet ingests a polyurethane-based adhesive?
If ingestion is suspected, it is important that your pet see a veterinarian as soon as possible. A point to stress: Do not attempt to induce vomiting at home! The glue can expand and harden within minutes, and obstruction or injury to the esophagus (swallowing tube) can occur while your pet is in the process of vomiting. It should also be noted that ingestion of as little as 2 ounces will likely cause obstruction in a medium-size (50 pound) dog!
How is the diagnosis made?
Radiographs of the abdomen often show evidence of the glue mass. An important side note is that this radiographic finding can sometimes be mistaken for “food bloat,” which is when your pet ingests a large amount of food resulting in distention of the stomach— one is deadly and the other is not. History is a critical part of arriving at a diagnosis, and it’s important to mention if you have this type of glue in your home, even if you think your pet cannot get into the area where it is stored.
How is it treated?
In cases where an obstruction develops, surgery is needed to remove the glue mass. Prompt identification of the problem and medical care greatly improve your pet’s chances of a successful outcome.
As always, the best treatment is prevention: If you use MDI-based glues, please take extra precaution to keep away from pets.
I have personally treated three cases of glue ingestion in the past couple of years, and it is my hope that this information will prevent me from seeing case number four! As always, please feel free to leave comments or questions.
Wellness: Health Care
The Eastern approach to caring for our pets
October 5 2011
Traditional Chinese Veterinary Medicine (TCVM) is one of the cornerstones of treatment in our referral hospital setting, and I wholeheartedly believe that it is an integral part of an all-embracing approach to therapy. I have observed its remarkable benefits countless times, especially in our surgery, oncology and aging internal medicine patients. I am frequently asked about the overall concept of holistic medicine, and I hope this post will help answer questions regarding this fascinating and emerging area of veterinary medicine, including how these practices can augment a Western approach.
What is it?
TCVM aims to diagnose and treat animals as a whole, rather than focusing on individual organ systems, as with Western medicine. The basic concept is the belief that illness can develop when the body is out of balance. Ultimately, the goal of TCVM is to put the body back into its natural equilibrium, as a way to help to treat and rid the body of disease. This can be achieved with a combination of acupuncture, herbs, nutrition and massage.
Acupuncture is the stimulation of a specific point on the body (acupoint), resulting in a “balancing” effect. Acupuncture has been practiced in both animals and humans for thousands of years in China. The ancient Chinese practitioners have discovered 361 acupoints in humans and 173 acupoints in animals! Stimulation of these acupoints induces the release of natural chemicals such as beta-endorphins, serotonin and other neurotransmitters. These chemicals, in turn, have positive effects on pain control and can generate the feeling of general well-being.
All those needles! Does it hurt?
Acupuncture treatments can cause the sensation of pressure, tingling or aching. For most animals, placing the acupuncture needles is painless. Some animals occasionally feel the initial insertion of the needle, but once in place, there is no pain. In fact, many animals become relaxed and some even fall asleep. This is a desired response and is a representation of Qi (energy) in the body. Acupuncture needles are sterile, single-use needles that are very fine and are not expected to cause discomfort.
How many treatments are needed?
The number of treatments depends on the nature, severity and duration of the disease. One or two treatments may be enough for a suddenly developed condition, whereas chronic conditions will often require 3 to 6 treatments to obtain results. Some degenerative conditions may need monthly treatments over time. Treatments may be given once a week to once every few months, depending on the specific problem. Each treatment can take 20 to 60 minutes, and an average of 10 to 20 acupuncture needles are typically used.
What are Chinese herbs and are they safe?
Chinese herbal therapy is another method of treatment in TCVM, and can be safely used in conjunction with other Western medications. The use of Chinese herbs in conjunction with other modalities (acupuncture and food therapy) can be a very useful and safe method to treat illnesses. Whereas acupuncture affects the movement of Qi, Chinese herbs improve the quality of Qi. This treatment combination can be very effective in bringing the body back to a balanced state. The individual herbs are often derived from portions of plants (root, bark, flower, seed), but they can also be mineral- (such as shell) or animal- (such as earthworm) based.
When is acupuncture indicated?
Acupuncture therapy can be effective with many medical conditions including:
The marriage of Eastern and Western medicine reflects advancement in care, and I am truly excited to be practicing medicine in a time when so much can be done for our pets to help improve their quality of life! Feel free to post any questions, comments or just share with us your personal experiences with holistic care.
Wellness: Health Care
The strange but usually benign case of reverse sneezing
September 28 2011
Reverse sneezing is a disconcerting event in which a dog makes an alarming respiratory sound, similar to a honking noise. This understandably leads pet owners to think that their dog is having trouble breathing and in grave danger. These episodes are followed by a warp-speed drive to the ER where we generally assess a happy dog wagging his or her tail and giving us the look of, “Not sure what all the fuss is about, but boy, that sure was a fun car ride!”
Reverse sneezing is a condition that usually does not need any treatment. It is called reverse sneezing because it sounds a bit like a dog “inhaling sneezes” or “snorting backwards.” These episodes are short-lived and usually resolved by the time of presentation, leaving us veterinarians to (embarrassingly) try to mimic the noise in the exam room. This video shows a typical reverse sneezing episode.
What is the cause and what is my pet experiencing when this happens?
The most common cause of reverse sneezing is an irritation of the soft palate and throat that results in a spasm. The dog’s neck will stretch outward and the chest will expand during the spasm as it tries harder to inhale. The trachea narrows during this time, and it’s hard to get the normal amount of air into the lungs. All of these actions together result in the disturbing display.
What are some other causes?
Anything that irritates the throat can cause this spasm, and subsequent reverse sneezing, including:
Further evaluation should be pursued if reverse sneezing becomes a frequent occurrence, as there may be a treatable underlying cause of the episodes, such as mites or allergies. In many cases, however, the cause cannot be identified.
What can I do?
Reverse sneezing itself rarely requires treatment. When the sneezing stops, the spasm is over. If the episode continues beyond a few seconds, sometimes massaging your dog’s throat can help stop the spasm. Also, it is sometimes effective to cover the nostrils for quick moment, which makes the dog swallow and helps to “clear out the irritation.”
Some dogs have these episodes their entire lives; while others develop the condition only as they age. In most dogs, however, the spasm is an occasional and temporary problem that goes away on its own, needing no treatment and leaving the dog with no aftereffects.
Are some dogs more prone to reverse sneezing?
This commonly happens to brachycephalic dogs (flat-faced babies such as Pugs or Boxers) that by nature have elongated soft palates. These breeds will occasionally suck the elongated palate into the throat while inhaling, causing reverse sneezing. Beagles, Yorkies and other small dogs are also particularly prone to it, possibly because they have smaller throats. Cats are very rarely prone to reverse sneezing, and if these signs are noted, veterinary attention is needed.
Wellness: Health Care
From silica gel packets to poinsettias, dogs ingesting these toxins may not need a trip to the vet
September 22 2011
During our emergency hours, I receive many a call that begins “my pet ate …” followed by the questions, “Is this harmful?” and “Do I need to bring him or her in?” Many of these inquiries are about substances that are not necessarily toxic, and I often give the recommendation of letting your pet remain happily at home.
I have compiled a list that represents the most common “nontoxic” toxins that I am asked about on a regular basis; knowing these may actually save you a trip to your veterinarian.
1. Silica gel packets: Packed with everything from vitamins to new clothes to protect against spoilage, silica gel packets are commonly ingested or chewed by dogs. Silica gel is chemically and biologically inert. If ingested, mild gastrointestinal (GI) signs are possible. Main risk: The packets can potentially cause an obstruction in the intestines if the whole packet is swallowed, especially in small dogs. (The packaging is often the biggest risk in the case of all these toxins. See note below.)
2. Oxygen absorbers: Found in packaged foods, oxygen absorbers contain iron powder, sodium chloride and carbon. By the time they are eaten by a pet, the iron powder has been converted to ferric oxide (rust!).
3. Ant and roach traps contain multiple active ingredients but at very low concentrations and are not likely to cause any significant clinical effects. These may also cause mild GI upset.
4. Birth control pill packets contain 21 tablets of estrogen and/or progesterone and possibly seven placebo pills. The hormone pills contain low levels of estrogen (less than 0.04 mg/tablet) and some contain iron. The levels of toxicity for estrogen are dosages greater than 1 mg/kg of body weight, and for iron, dosages of greater than 20 mg/kg. These levels are not often reached by ingestion of birth control pills. A 25-pound dog would need to eat about 300 pills!
Other current methods of birth control, such as the NuvaRing, contains 11.7 mg of a progesterone and 2.7 mg of an estrogen; ingestion of this product rarely reaches the 1 mg/kg toxic levels.
5. Toilet water with tank “drop-ins” can be corrosive in their concentrated forms (the actual gel or tablet) but are only mild GI irritants once diluted in toilet water. Drinking small amounts of toilet water should not be of concern. If your pet has raided the toilet and lapped up the bowl contents, you can dilute the toilet water that was ingested by encouraging your pet to drink his or her “normal” water or other fluids such as chicken broth.
6. Fertilizers containing salts of nitrogen, phosphorous, potassium (N-P-K): In most exposures, these are only GI irritants. Be sure to check for added iron, insecticides or pesticides, which can increase toxic potential. If the iron level is greater than 5 percent, more significant effects may occur.
“Organic” Fertilizer/Bone Meal/Blood Meal products are very attractive to dogs, and the primary concern here is if there are any insecticides mixed in. Another concern is if the product is moldy or rancid, as animals can develop a bacterial gastroenteritis (a bacterial cause of vomiting and diarrhea) or develop severe tremors from tremorgenic mycotoxins that are found in moldy substances. There is also a risk of impaction in the intestines if a large amount is ingested.
7. Lawn treatment herbicides, in general, do not cause severe systemic signs when a dog or cat has access to an appropriately treated yard. Mild GI upset can be noted when the application is fresh, but less likely to occur once the product has dried.
8. Fire logs generally contain sawdust, wood chips, peanut shells, petroleum wax, ammonium chloride and potentially a metal, such as copper to produce flame color. Systemic toxicity is not expected but can cause GI upset and pose obstruction risk.
9. Poinsettia ingestion causes mild GI upset only. The myth of the “deadly nature of the poinsettia plant” evolved from a 1900s rumor of an Army officer’s child dying after eating one leaf. Later, human studies revealed that a toxic dose for a 50-pound child is more than 600 leaves.
10. Glow jewelry contains Dibutyl phthalate, which has a very unpleasant taste. Signs you might note at home include drooling, hyperactivity and head shaking. Treatment includes giving a tasty treat and wiping off any liquid that remains on the fur. (Take your pet into a dark room to find any residual glow on the fur!)
11. Glue traps are commonly used to kill rodents and insects (and hopefully this will never be an issue in your home, as they are a cruel way of rodent control). Most contain benign attractants only, such as pheromones, and they are considered nontoxic. (However, it is important to make sure other substances have not been added, such as rat bait.)
If ingested, the risk is for an intestinal obstruction. If the animal has had exposure to its skin, the main concern is the method of decontamination. SOLVENTS SHOULD NOT BE USED! Instead, use vegetable oil, mineral oil or peanut butter to work the glue out of the fur and then bathe with dish soap.
12. Antacids: These over-the-counter medications commonly contain calcium carbonate, magnesium hydroxide and aluminum hydroxide; the main concern is for the development of vomiting, diarrhea and constipation. Verify that the agent does not contain salicylates. If the product contains salicylates, then you should call your veterinarian or local emergency clinic.
13. Human thyroid supplements overdoses are well tolerated by dogs due to poor intestinal absorption and differences in the way the medication is metabolized. Severe signs are not expected at dosages below 1 mg/kg in dogs. Higher doses can result in GI upset, hyperactivity, high blood pressure, lethargy, fast heart rate and an increased breathing rate. If these are noted, medical attention is needed.
14. H2 blockers, which include famotidine (Pepcid), ranitidine, cimetidine and nizatidine, are relatively benign and oral ingestion of greater than 10 times the therapeutic dose only results in mild GI upset.
15. Triple antibiotic and steroid creams only cause mild clinical signs, if any, as they are poorly absorbed orally. Vomiting and diarrhea may occur and you may see signs from the steroids (increased water consumption, increased urination, increased appetite and panting) but these are short lived and will be self-limiting. There is a risk of obstruction if the tube or cap is ingested.
The greatest risk of many of these “dietary indiscretions” is not from the substance itself, but from the packaging it is contained in which can cause an intestinal obstruction. Small dogs are at greater risk of developing an obstruction from packaging than larger dogs due to the smaller size of their intestines. For example, a silica gel packet can more easily move through the larger-sized intestine of a Labrador, than it can a Chihuahua. Clinical signs of a developing obstruction can include vomiting, diarrhea, painful belly, lethargy, and/or loss of appetite. If any of these signs are noted, seek care from your veterinarian immediately.
What about inducing vomiting at home?
We never recommend it for four main reasons:
1. Owners may misinterpret the ingredients and induce vomiting of a potentially hazardous substance.
2. There is a risk of causing aspiration pneumonia if not properly done.
3. There is a risk of an object getting lodged in the esophagus on the way back up, which causes another set of problems.
4. We induce vomiting by a simple small injection, which is much more pleasant for your pet than forcing a cup of nasty tasting hydrogen peroxide down his or her mouth.
One final word of CAUTION:
The above guidelines are just that—guidelines—and any ingestion of any questionable substance should always be followed up with a phone call to your veterinarian or local emergency clinic. Anything can be dangerous in the right quantity—even water!
Wellness: Health Care
The A-Bee-C’s of Acute Allergic Reactions
September 14 2011
I kicked off my Saturday morning shift by treating the cutest puffy-faced puppy; he was experiencing his first acute allergic reaction. Like many dog owners, this puppy’s mom had never witnessed this kind of sudden reaction, and arrived at our ER in a panicked and perplexed state exclaiming, “he was normal just a minute ago!”
Acute allergic reactions are a common emergency, and the culprits are generally bees, wasps and spiders. This typically happens when our curious canines can’t resist a good sniff and inspection of the interesting creature moseying along the ground or floor.
Bites and stings can cause clinical signs that range from mild to life-threatening reactions. Mild reactions are generally limited to a swollen or puffy face, swelling and redness around the eyes, lumps and bumps over the skin, redness of the skin, head shaking and itchiness.
Severe reactions are called anaphylactic reactions, which are nearly immediate and can lead to life-threatening alterations in the body. These symptoms can include vomiting, diarrhea, staggering, pale gums, swelling of the larynx leading to difficulty breathing, and sudden collapse. Most pets that I see for anaphylaxis are reported to have vomited once followed by collapsing, and when I perform my physical exam, I generally observe pale gums and a poor pulse indicating a state of shock.
Veterinary attention is required if your pet is showing any signs of an allergic reaction. While seeking medical care, follow these steps:
What to Do:
“A” is for assist: If your pet was stung, see if the insect and stinger are still attached. If so, try to remove the stinger by scraping it out with a credit card or other stiff material. Alternatively, use tweezers by grasping the stinger, which is located below the venom sac.
When a honeybee stings, its stinger becomes detached from its body and the bee then dies. What’s left in the pet’s body is the stinger and a tiny piece of fleshy looking tissue, which is the venom sac. (Here’s a short video demonstration.) Wasps or bumblebees, on the other hand, can sting over and over again because their stingers do not become detached from their bodies.
“B” is for baking soda: To help neutralize some of the acidic venom, apply a paste mixture of baking soda and water to the sting area.
“C” is for cool compress: Apply a cool compresses to the area to help reduce the swelling and pain, as well as to help with constricting the blood vessels to “slow” the spread of the insect venom.
Have your pet examined immediately by your veterinarian if there are any signs of facial swelling, vomiting, breathing difficulty or collapse. Mild clinical signs can progress to severe clinical signs in a short period of time and early treatment will generally prevent continued progression of the reaction
What NOT to Do:
Can Anaphylaxis be Prevented?
In general, there is no way to predict which animals will have an allergic reaction, whether it will be mild, or whether it will progress to life-threatening anaphylaxis. Some pets have no reaction to a sting one time, and then have a severe reaction the next. The “Bee Gods” are not kind to my own baby girl, and one hones in on her bald little butt at least three or four times a year. Luckily, she has yet to develop a reaction.
For animals who do have an established history of being allergic to insect bites, I often get asked about giving Benadryl, which is part of the treatment protocol in allergic reactions. In the hospital setting, Benadryl is given by injection into the muscle, which works much faster than giving the medication orally. However, owners who are out on hikes and away from veterinary care often raise the concern about needing more immediate treatment. In these cases, you can carry with you, and give if needed, one milligram of Benadryl for every one pound of body weight (for example, a 50-pound dog can get 50 mg of Benadryl). This is not a substitute for veterinary care, but it can be helpful at “buying time” as you make your way to your veterinarian for evaluation.
You can also ask your veterinarian about getting a prescription for an “epi-pen” if your pet has experienced a true anaphylactic reaction in the past. This is a special syringe and needle filled with a single dose of epinephrine, and is similar to the type used for people who are highly allergic. You can carry this with you on trips or hikes and use if your pet experiences another severe reaction.
If you suspect your pet is experiencing a reaction from an insect bite, whether it is mild or severe, please contact your veterinarian or local emergency hospital for guidance and advice.
Wellness: Health Care
Advice for counting calories and dealing with “the look”
September 7 2011
Like so many pet owners, I am in the constant back-and-forth battle with “dimple butt” in my dogs, and there are many things that make a weight loss (or weight maintenance) program difficult. For me, it’s “thaaaat looook.” Yes, you know which one I’m talking about, and I just can’t seem to say no to those big, pleading (and I’m sure starving) eyes. As a guilt-stricken result, I end up sharing a portion of whatever it is I’m enjoying, contributing to that Dobie derriere.
There are countless recommendations, formulations and opinions with regards to which approach works best for weight loss. With all the options out there, I have found this “rough-edged” approach to work for our dogs and for our lifestyle. It is straightforward, it does not require a change in their normal food and allows for tasty “treats” to reduce their feelings of hunger. It may be a slightly less scientific approach, but it is one I have found to actually work each time I have recommended it.
Let’s break it down. I’ll start by teaching you how to determine your pets’ daily caloric needs and how to adjust their nutrition to meet weight-loss goals. Finally, I’ll offer some tips on how to make them feel less miserable in the process (after all, who doesn’t hate dieting?).
How many calories should my pet have each day?
Knowing how many calories your pet needs each day is the first thing you need to determine when approaching a weight-loss program. Food “guess-timations” are frequently incorrect because we often judge how much to feed based on how hungry our dogs appear to us. This is not the best indicator of caloric needs because many of our pets will eat whatever is placed in front of them. Animals also have a basic instinctual drive to look at us whenever we are eating, which we often interpret as hunger, leading to overfeeding.
There are many formulas for determining your pets’ daily caloric needs, which are known as Resting Energy Requirements (RER), but I find this one to be the easiest to “plug and chug”:
Daily calorie needs = 30 x (your pet’s weight in kilograms) + 70
For example, if your pet weighs 15 kg: (30 x 15) + 70 = 520 calories per day
To get your pet’s weight in kilograms, divide the number in pounds by 2.2
For example, a 33-pound dog weighs 15 kg. Here’s the math: 33 divided by 2.2 = 15
Next, look at your pet food bag to find how many calories are present. If you are having difficulty finding the calories per serving of your pet food, let me know the brand and I’ll see what I can do to find out for you.
If you home-cook for your pet, determining calories can be a little more complicated as you need to consider the individual elements that make up their diet. However, the concept remains the same, and an excellent resource for the caloric content of individual foods used in home-cooked diets can be found at Stombeck's Home-Prepared Diets for Dogs and Cats.
How to start a weight loss diet
I prefer the “low and slow” approach to weight loss (after all, it is unlikely that our pets are wanting to get into that little black dress by next month). For weight loss, simply feeding the calculated RER calories alone should be adequate for reducing weight over time with no further “diet modifications” needed. With this approach, most pets will typically loose 1 to 2 pounds per month, achieving their ideal weight in 6 to 8 months. The best thing about this approach is that you don’t have to change the diet or buy an expensive prescription weight loss formula.
Continue to weigh your pet every month until an ideal body weight is achieved. If there is no significant weight loss after 1 to 2 months on their calculated RER, then I recommend cutting back their total calories by 10 percent (most veterinary nutritionists recommend a 10–20 percent calorie cutback).
Continue to reweigh your pet every four weeks and continue to decrease the total calorie intake by an additional 10 percent until your pet’s ideal body weight is reached.
When they have finally reached their ideal body weight, simply continue to feed that amount of dog food daily, as long as they continue to maintain this ideal weight (meaning, no further weight loss or gain).
Two tips to ease the pain
When our babies are acting extra hungry, we give them a cupful of green beans, giving them a feeling of fullness and the joy of having been offered a treat, without adding many calories. This trick also works great if or when you need to decrease the food amount by 10 percent—just add in a big scoop of the green beans as “filler” each time you cut back the food. And because the calories are so minimal, you can get away with not having to calculate them into the daily caloric needs, which makes life easy. It’s kind of like Weight Watchers where you can eat all the salad you want for no points.
Here is a working example:
One final note: These recommendations assume that you have a healthy dog. If you have an older dog, I recommend you have a physical exam performed by your veterinarian as well as blood work to ensure that there are no underlying metabolic problems such as hypothyroid disease or Cushing’s disease, which can be the source of weight gain or an inability to lose weight.
I hope this approach to weight loss and management offers easy guidelines to help your pet reach its ideal, healthy body weight. Please feel free to ask questions if I can help in any way.
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