Showing posts with label veterinary advice. Show all posts
Showing posts with label veterinary advice. Show all posts

Friday, March 28, 2014

#FurbabyFridays: Pets and #Chocolate Can Be a Deadly Combination


Hello and welcome back to Furbaby Fridays with Dr. Tammy. This week we are counting down to Easter and I thought today would be a great time to remind folks about the dangers of chocolate. Yesterday, one of my clients came in because one or both of her dogs ate dark chocolate truffles—enough to make them both seriously ill. Their visit reinforced the need to take time out to discuss the dangers of chocolate for our fur babies.

 This tasty treat comes in all shapes and sizes and formulations whether in cocoa products like candies, cakes , cookies and brownies, but also in cocoa beans and mulches.  The most accidental exposures of pets to chocolate of course occur more around the holidays and Easter is a big one.

Because dogs tend to be the pets that tend to eat just about anything, we don't usually see cats with this toxicity, but there are a few of those pesky felines who pretend they are dogs and ingest some odd things. So to be safe, keep chocolate away from all fur babies.  This includes some cocoa bean hull mulches. Not only do the mulches smell like chocolate Pop Tarts, they are readily available for pet for some pets because of their use in gardens and landscapes. Of course the makers of the mulches will say there has only been one documented death from the ingestion of these kind of mulches, this does not mean that animals are not sick from them. In fact, even Hershey one of the makers of these mulches admit that 50% of dogs who ingest their mulch can get sick from it.  Here's an article by snopes.com that talks a bit more about it.


What makes chocolate toxic to animals?


Methylxanthines are the culprits here, specifically theobromine and caffeine. That's right. There are TWO toxic components in chocolate and each will vary in concentration depending on the type of product. The rule of thumb is the darker the chocolate the higher the amounts of both of these compounds. White chocolate has 0.25mg theobromine per ounce and 0.85mg of caffeine per ounce. In contrast, dry cocoa powder has 737mg theobromine and 70mg of caffeine per ounce.  Now what does that mean? 

Animals can show mild signs after only ingesting 20mg/kg of either theobromine or caffeine. Severe signs are seen at 40mg/kg and seizures at 60mg/kg. So if you have a 20 pound dog (roughly 10 kg) it would have to eat 400 mg of the toxins to start showing some signs.  So only 1/3 of an ounce of the dry cocoa powder can be dangerous and only one ounce of the cocoa bean hulls in the mulches could do it as well. Less than 1 ounce of milk chocolate per pound of body weight is potentially lethal for dogs. Milk chocolate is nearly 100 times as toxic as white chocolate. Baker's chocolate is SIX TIMES more toxic than milk chocolate. 

A lot of figures, I know but I wanted you to see the comparisons. If your dog decides he likes your dark chocolate candy bar you've been saving in your purse, you very well may have an emergency on your hands. 

 For an article about chocolate intoxication and a chart that includes the amounts of the types of chocolates and caffeine sources click HERE. It's a page on the ASPCA website with articles aimed more for veterinarians. The article is a PDF that will download to your computer if you click on the link.

It's not only the actual amount of chocolate we have to worry about when our pets ingest these kinds of foods. More often than not, the ingestion takes the form of eating candy in wrappers. Those can be just as bad leading to obstructions in the stomach and bowel loops. Even if the mulches are of the variety that have been treated to remove the theobromine, the debris itself could cause an obstruction if enough is eaten.  

What are the clinical signs to look for?


Usually withing six to twelve hours of ingestion you will see the first clinical signs. These include polydipsia (drinking a lot of water), vomiting, diarrhea, bloating and restlessness. If enough of the chocolate has been ingested, the signs can progress to an animal that ends up extremely agitated/hyperactive, urinating a lot, tremors or even seizures.  Other symptoms include high heart rates, arrhythmias, elevated body temperatures, coma and even death.  It's the arrhythmias that can cause death in these patients so it's imperative that you seek immediate veterinary care if your pet gets a hold of any kind of chocolate. It's better to be safe than regret it later.

How is chocolate intoxication treated?


As soon the pet arrives, the veterinary staff will be in motion. Stabilization first involves decontamination of the stomach by inducing vomiting. This will be done only if the patient is stable enough for it to happen. If your dog is seizuring, the induction of vomit will NOT occur. Instead the seizures will be brought under control first. Once more stable then decontamination will occur using stomach tubes to remove as much of the chocolate that remains and to administer activated charcoal without sorbitol. (In the paint ball toxicosis article you will recall that sorbitol is one compound that can cause issues all on it's own. 

If it's been within a two hour period of ingesting the chocolate, emesis (vomiting) will be induced. Trust me, some of the dogs that have come into my clinic after eating chocolate have amazed me with the sheer amount of the stuff in their stomachs. One patient at a box of mint cookies covered in dark chocolate. My treatment room reeked of minty chocolate for hours after that pooch tossed his cookies...pun intended. ;)  

Intravenous fluids, close monitoring of vital signs to make sure elevations of temperature and heart rates don't occur. If the signs do progress, then medications are administered to control seizures and arrhythmias. Usually our patients present early enough that just 12 hours of IV fluids, and monitoring are all that's needed after the decontamination. Activated charcoal is sometimes split into three different doses in order to continue to absorb any chocolate that got into the intestinal tract.  The patients that have the longest recovery are those who are treated after the bad symptoms have already started or they've ingested chocolate that contains other "ingredients" such as marijuana, laxatives, "magic" mushrooms and other recreational drugs. 

So do yourself and your pets a huge favor and lock up all products containing chocolate and caffeine. Even if it's white chocolate containing very little toxin per ounce, it's best to just keep it out of reach. Don't leave any candies out in dishes, Christmas stockings, wrapped under the Christmas tree, in Easter baskets accessible to pets, boxed chocolates on Valentine's Day, or baked goods out where your pets have access.  I know that all seems like common sense, but you'd be surprised by the number of folks who say "my dog never jumps up on the counter. Why would I put the chocolate away?"  Here's another good one, "It's a dog. They don't eat chocolate."  

This is where I usually hear Bill Engvall's "Here's Your Sign" routine.  LOL





Friday, August 2, 2013

#FurbabyFridays: Dealing With Elderly Pets And Their I Know More Than You Vets Owners


Welcome to Furbaby Fridays with Dr. Tammy. This week has been filled with so many frustrating cases and clients. I thought I'd share an article I posted here 1 !/2 years ago and it sums up what my colleagues and I had to deal with working in our very busy veterinary hospital over the last month. For myself, it was nearly verbatim a conversation I had with a male owner concerning his very sick cat. He screamed at me when I couldn't just lay my hands on his cat and tell him for sure that the mass I felt in Miss Kitty's belly was in fact going to be terminal. Never mind he waited five days to bring her in this last time. She was in very big trouble and I had to try to get through to him. Ultimately he did go to the specialist as I recommended, but it took two more doctors to tell him the same things I did...at two different clinics...before he came to grips with the severity of his pet's illness.


Ever have one of those days where no matter what you do, or what you say you just can't seem to make a difference? Today was one of those days for me and a few of my fellow veterinary colleagues. Each patient chart that turns up in the rack is a potential puzzle to be solved. Sometimes we try to come up with ideas of what could be ailing the pet before we go in, just to see if our intuition is on target...or way off depending on what kind of information the pet owner is willing to divulge to our staff before we get in there.

It can be like pulling teeth getting an accurate history. I've had clients refuse to give any details about what is up with their furry companion until I get in there, and still they keep quiet, thinking that just by laying my hands on the animal I will miraculously know what is making "Fluffy" not want to eat for the last week. Starting with the usual questions about what foods they animal is being fed and it's "potty" habits can be the most challenging. 

"I don't know the name of the food, Doc. It's the one in the yellow bag."  

"I got four cats, how am I supposed to know who pissed or shit in the box?"  

"What does his food have to do with why Ranger is itching and keeping me up all night?" 

"Flea control? Naw, I never saw a flea on him so it ain't flea allergy."


Wanna make a bet?


Today I had one woman say to me that she knew the reason her cat was so ill was because she switched his food over to a raw food diet.  That was over five days ago and he still wouldn't eat ANY food. I told her that the diet switch may have been the final trigger that set the anorexia off, but probably not the cause. Do you know what she said to me? "Well, you're just guessing now. You have no proof of that."  

I stared at her for a half a beat and then let her have my sweetest smile.  "You are the one guessing here. It's time we do some blood work and figure out what the heck is wrong with Angus instead of guessing until we're both blue in the face."

"Well, I don't see the point in spending a lot of money to find out what's wrong if there's a chance the tests will come out normal."

I had to really restrain myself from rolling my eyes. "Well, you're obviously worried about Angus, otherwise you wouldn't have returned here three times for us to check him out. I think it's time you take our recommendation and see if we can at least find out what's NOT making him sick."

"If it turns out to be the food that's making him sick, do I have to still pay for the tests?"

"Yes. The costs are for running the tests and interpreting the results. If we don't do some sort of testing, we'll keep guessing and throwing treatments at him that may or may not work one bit."

"Can't you just tell me what's wrong by looking at him? Are you a newly graduated doctor? Why can't you just tell me right off what's wrong? My old vet who retired ten years ago could do that. I never had to pay for these expensive tests."

Now I am really biting my tongue and hoping that the blood from the wound doesn't seep out onto my lips. "I graduated over 20 years ago now, Mrs. Green and have been in practice ever since. We can get into why properly diagnosing pets often needs more than just the physical exam, or we can do the testing you came in for today. You agreed to come back if Angus didn't respond to the fluids so that we could do these tests."

"You vets just want all of my money. I've had cats all of my life and I never had to do this stuff before."

"Angus is nearly 17 years old now and there are a lot of things that could be going wrong with his kidneys, liver, or other organs. He could have a cancer somewhere that we can't feel on exam yet, or the start of diabetes or hyperthyroid disease. The only way to know is to do the blood tests."

"Well, I just don't want to spend any more money on him.  The treatments you all gave him didn't work. He's sick again.  Why won't he eat?"

We stare at each other a few more moments. This woman brought her cat into the hospital THREE times now and has refused to do anything for him other than subcutaneous fluids. She was told repeatedly that this was just to help with his dehydration and wouldn't tell us anything about his condition at all.  "What do you want from me, Mrs. Green?"

"I want you to fix my cat. Tell me what food to feed him so he'll eat again. Tell me what's wrong with my cat."

"We have to do these tests to figure out what is going on so we can treat him properly."

"I don't think the tests will tell us anything."

At this point I'm so tempted to tell her Angus has a terminal cancer, but know that's not what she wants to hear and I don't know that's what's wrong with him. "Why did you come back today, Mrs. Green?"

"I want you to tell me what is wrong with my cat and fix him."

"I'm trying to do that but we need the tests so we can do this the right way."

"Why can't you just look at him and the notes from the other doctors and figure it out that way? I know I'm right and it's because I changed his food."

At this point, I basically want to pull my hair out. Angus has lost another pound in the last week. That's over 10% of his body weight gone in less than 7 days.  His anorexia had been going on for the last two weeks, off and on. It was now five days since he ate anything at all. This wasn't good at all and until we figured out what was going on, he could continue to go downhill. I changed tactics a bit. "I know you love Angus and want what's best for him. I wouldn't recommend these tests if I didn't think it was the first steps we need to take in order to help him. That's exactly what the other doctors have recommended as well."

She bit her lip a few times. "Well, if really you think the tests would help find out what's going on, then let's do them.  If I would've known they were so important to his health, I would've done them sooner. You know, it's not a matter of the money. I'll do whatever I need to do to help him.  I just don't want to do any unnecessary tests if he can be fixed with just a shot."

Oy! Does anyone else feel like they're in the middle of an Abbott and Costello movie? I did at the time it all happened and still do reading through it again!
~Dr. Tammy


Friday, March 29, 2013

#FurbabyFridays Warning About Easter Lily Toxicity in Cats


For those of you who have visited with me this entire month, you may have noticed a trend. I've been working my way through some of the common toxins that I've seen with my patients. Since this weekend many will celebrate the Easter holiday, I decided today's spotlight toxin should focus on one that can happen any time during the year and not just now.

Easter Lily
Lily toxicity is unfortunately a very common presentation to veterinary hospitals all over the country. People receive beautiful bouquets of flowers from loved ones and secret admirers all the time. Because lilies come in a variety of types and colors, they are a popular addition to these gifts. Unfortunately, these gifts of love and admiration can be deadly for our feline family members.



Star Gazer Lily


Easter lilies, tiger lily, Japanese Show lily, some species of day lily and certain other members of the Liliaceae family can cause kidney failure in cats. All parts of these lilies are considered toxic and consuming even tiny amounts can be life threatening. Many people are not aware of the dangers these kinds of lilies pose so if you're expecting a florist to warn you about the potential hazard, good luck with that. As more and more people learn about it and help to educate others, one day we will see a decline in cats admitted to emergency hospitals on death's door.




The exact toxin so far has not been identified. Just like with the grape and raisin, we are left stumped as to why it happens. We do know the toxin is water soluble and kidney damage occurs within 24 to 72 hours of ingestion of even just a few bits of a leaf or flower petal.

There are no known diagnostic tests to check for lily toxicity. The tests performed by your veterinarian center on checking the function of your pet's kidneys. Treatment must be done early on in order to be successful. Just like with most ingested toxins, the emptying of the stomach contents is recommended if it's within 2 to 4 hours of ingestion of the plant. Activated charcoal, IV fluids for at least 24 hours and other supportive care is needed to ensure the patient recovers. If left untreated, kidney failure usually begins within 2 to 4 days. By this point there are very few treatment options left and the death rate from lily toxicity is very high.

What are the common signs of lily poisoning?

These early signs often develop within the first 6 to 12 hours of exposure
  • vomiting
  • inappetance
  • lethargy
  • dehydration
Left untreated, the signs worsen as kidney failure develops
  • not urinating at all or urinating too frequently
  • not drinking at all or excessive thirst
  • walking drunk
  • diorientation
  • tremors
  • seizures
  • death
Once again...THERE IS NO ANTIDOTE for lily poisoning. Prompt veterinary attention is necessary.

What about other types of lilies?

Peace Lily
Not all lilies cause kidney failure but there are some that are mildly poisonous. These kinds contain oxalate crystals that irritate the mouth, tongue, pharynx and esophagus. With these, you will see minor drooling. Even so, it's better to be safe than sorry with ingestion of lilies of any kind.  Examples of these less toxic lilies include
  • Peace Lily
  • Peruvian Lillies
  • Calla lilies



Add Cala Lilies


The take home message here is to avoid having lilies of any kind around your cats. If you are planning on sending a flower arrangement to someone and you know they have cats, ask the florist to use alternatives to lilies. If you suspect your cats have been munching on any part of the lily that does make it into your home, consult with your veterinarian IMMEDIATELY.  If you see any of the signs discussed above, seek veterinary help ASAP. Time is your enemy in this situation. 

~Dr. Tammy


Additional resources that can be helpful

Wildfire Romance Series