Archive for the ‘Veterinary Emergency’ Category

I Can’t Believe He Ate That!

December 11, 2011
Needle lodged within the intestinal tract © Cuyahoga Falls Veterinary Clinic
Dogs and cats eat some pretty darned crazy things! Sure, I can understand nabbing a loaf of bread from the kitchen counter or sneaking some “kitty roca” out of the litter box. But why on earth eat a sewing needle, panty hose, Lego pieces, or mama’s favorite diamond earrings? Just when I think I’ve seen it all, something new surprises me.

Dogs, more so than cats, tend to be “repeat offenders.” I recall one Labrador in particular who had six surgeries over the course of his lifetime to remove socks lodged within his intestinal tract (in spite of counseling his humans repeatedly on picking up their socks). As many surgeries as this dog had, we should have installed an abdominal zipper!

Not all cases of foreign body ingestion have such happy endings, particularly if the foreign object has perforated through the wall of the stomach or intestinal loop. This allows leakage of nonsterile gastrointestinal contents into the normally sterile abdominal cavity resulting in widespread inflammation known as peritonitis. With emergency surgery and post-operative intensive care, many of these patients survive, but it is certainly becomes a big deal, both for the patient and the pocketbook.

Esophageal foreign bodies are notoriously difficult to remove, particularly if they’ve been lodged for more than a day or two. (The esophagus is the muscular tube that transports food and liquids from the mouth down into the stomach.) Even if the foreign object is successfully removed, the resulting inflammation within the esophagus can result in the formation of a stricture (narrowing of the esophageal lumen) and chronic, severe swallowing difficulties.

Some dogs and cats are lucky. The foreign objects they eat pass freely without any ill effects. I see the not so lucky ones with objects that have become lodged within their gastrointestinal tracts. There are two means to retrieve a gastrointestinal foreign body, surgery and endoscopy. An endoscope is a long telescope device that can be passed through the oral cavity, down the esophagus and into the stomach and upper portion of the small intestine. The endoscope allows visualization of the inside lining of the bowel and its contents. A grabber type instrument can be deployed through a channel in the endoscope to grab the object and then pull it out through the mouth. Endoscopy requires general anesthesia, but it is often preferred over surgery because of its less invasive nature.

In order for endoscopy to be of benefit, the foreign body must be located within the esophagus, stomach, or the very upper part of the small intestine (this is as far as the endoscope can reach). Some objects (coins, needles, tennis ball fragments, cloth) are well suited to being removed endoscopically because they are more “grabbable.” Objects that have traveled further down the gastrointestinal tract (beyond reach of the endoscope) or are without “grabbable” surfaces (large rounded bones, balls) are better retrieved surgically.

What can you do to prevent your dog or cat from eating inappropriate things? First and foremost, “baby proof” your home and yard for your pet. Anything unsafe that your little snookums might want to “mouth” should be put away and out of reach. This is particularly important when caring for a puppy or kitten. Secondly, it pays to know your pet- some cats and dogs never grow out of the habit of putting strange things in their mouths. Some adult cats continue to graze on dental floss found in the bathroom garbage pail, and some adult dogs continue to scarf down panty hose and underwear. If you provide chew toys or bones to your dog, supervise carefully to be sure that he’s a nibbler rather than a “swallow it whole” kind of guy. The best defense against gastrointestinal foreign bodies is avoidance of the things your pet might be willing to swallow. In some extreme cases, I’ve encouraged folks to muzzle their dogs when outdoors unsupervised or on walks, so they can relax knowing that their dog cannot gobble something down in the blink of an eye.

Perhaps my most memorable foreign body retrieval was performed on an adult Saint Bernard. X-rays suggested something was lodged in her stomach, but I couldn’t be clear exactly what the foreign material was. I passed my endoscope down into the stomach and saw an intact hand. I thought, “Oh my goodness!” I looked around a bit more and spotted a foot, and then what looked like some human hair. My heart was racing until I finally removed what I could identify as the chewed up remains of a troll doll! Afterwards I chuckled remembering that the view I get through the endoscope is magnified significantly!

What crazy thing has your dog or cat eaten in the past? Did it pass on its own or was it necessary for your vet to come to the rescue?

Happy holidays to you and your loved ones,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

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Murphy and Ruska

September 5, 2011

I refer to my last week at work as the “Murphy and Ruska Show” in honor of two delightful patients who arrived at my doorstep one day apart, each with a life-threatening disorder called pneumothorax. “Pneumo” means air and “thorax” refers to the chest cavity, so “pneumothorax” is air within the chest cavity.  If you’re scratching your head wondering, “Isn’t there supposed to be air in the chest cavity?” here’s what you need to know.  While the lungs are air-filled, the space surrounding the lungs, known as the pleural space, is normally devoid of air.  Pneumothorax refers to the accumulation of air with the pleural space. In order to understand how a pneumothorax causes difficulty breathing, it helps to think of the chest cavity as an empty barrel into which the lung lobes expand as they inflate (like balloons filling with air).  The lungs readily inflate with minimal effort because negative pressure (a vacuum effect) normally exists within the pleural space.  Fill the pleural space with air and the negative pressure is disrupted resulting in more effort required for lung expansion.  Make sense?

Murphy and Ruska were both observed by their families to experience an abrupt onset of labored breathing. Murphy also became subdued, a marked deviation from his normal wiggly-waggly Labrador self and he was unwilling to lie down.  Clever Murphy figured out that lying down makes labored breathing even more of a struggle.  In addition to working extra hard to breathe the normally ravenous Ruska refused her breakfast, a sure sign that this sweet Shepherd was off her game.

Normal Chest

The two most common causes of pneumothorax are penetrating chest cavity wounds that allow external air to enter the pleural space and leakage of air from the surface of a diseased or injured lung lobe.  Pneumothorax is readily diagnosed with a chest x-ray.  Have a look at the accompanying normal and abnormal x-ray images. In both views, the dogs are lying on their sides with their head end to the left and their tail end to the right.  You can see the spines at the top of the images.  Note the heart, the whitish round structure in the middle of the chest cavity. Air shows up black on an x-ray. Now notice how much more black (air) there is surrounding the heart in the pneumothorax image compared to the normal chest. Makes you want to become a radiologist, eh!

Pneumothorax

Murphy and Ruska were referred to me to figure out why they had leaky lung lobes.  The most common cause of pneumothorax is a blunt blow to the chest cavity (hit-by-car trauma is classic) forceful enough to tear a lung lobe and allow leakage of air into the pleural space. Ruska and Murphy were both closely supervised with no known trauma history.  Computed tomography (CT scanning) is my test of choice for solving the mystery of the leaky lung lobe. Murphy’s scan revealed multiple small blisters (aka, blebs or bullae) on his lung lobe surfaces.  Just as in people with this abnormality the blisters are thin-walled and capable of spontaneous rupture allowing air to leak into the pleural space. Fortunately, as was the case with Murphy, most lung blisters are self-sealing within a few days. Worse case scenario, a stubborn leaker can be surgically sealed. Murphy’s family has been forewarned that his multiple blebs will likely mean multiple penumothorax episodes.  They know what to be watching for and will return with Murphy any time, day or night, should his labored breathing recur. Murphy is now home, happy as can be with instructions to be a couch potato for the next two weeks with hopes of avoiding disruption of the body’s “bandaid” on his leaky lung blister.

Ruska’s CT scan documented a small walled off abscess on the surface of one lung lobe.  Given the time of year and where Ruska lives and plays, I’d be willing to bet my first born child that a foxtail plant awn is living within that abscess.  Fortunately, Ruska’s lung lobe leak resolved itself, and the pros and cons of surgically exploring the site versus long-term antibiotic therapy (foxtails shuttle bacteria wherever they migrate) were discussed and are still being considered.  I should be hearing back from Ruska’s mom sometime this week.  For now, this big girl is back home and, like her friend Murphy, she is doing her best to be a cooperative couch potato (easier for a Shepherd than a Lab!).

Our emergency room vets are used to seeing pneumothorax patients because hit-by-car trauma is so prevalent.  As a small animal internist I rarely see them, yet here were two within one week! (I suspect the third is on its way.)  Have you or a loved one (human or canine) experienced a pneumothorax?  Please do tell.

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

The Elephant in the Middle of the Exam Room

August 1, 2011

My dual career as an author and a practicing veterinarian provides me with a unique vantage point. Not only am I privy to the issues my veterinary colleagues are stewing about, I also receive a plethora of emails from my readers candidly venting about their experiences as consumers of veterinary medicine.  It’s rare that those on both sides of the exam room table are growling about the same issue, but these days this is certainly the case.

See if you can identify the elephant in the exam room based on the following data that has appeared in current veterinary news feeds along with quotes from recent correspondences with my readers:

– The number of pet visits to veterinary hospitals is dramatically decreasing (DVM Newsmagazine, June 2011), and a special session was held at this year’s conference of the American Veterinary Medical Association to explore ways to increase public awareness about the importance of annual checkups for pets.

– “In my opinion, most of the decline in veterinary visits is primarily due to the bad economy. If you are barely scraping by, you are certainly not going to the vet for a very pricey annual exam, especially if your pet seems fine.”

– While pet spending is up, the market isn’t growing fast enough to support the number of new veterinarians entering the veterinary profession. (DVM Newsmagazine, June 2011) Veterinarian supply is growing faster than pet owner demand. (The Bayer Veterinary Care Usage Study 2011)

– “Sadly there are some veterinarians who see hospitalization fees as a revenue stream and do not inform clients that no one will be supervising the pet they recommend be hospitalized. While one tends to like to think of their vet as a kind, caring person and many are, some are more business than heart.”

– Eighty-nine percent of current veterinary school graduates have student debt.  The average student loan debt of students graduating in 2010 from veterinary school was $133,873 (15% have debt in excess of $200,000) and the average starting salary was $48,674. (Veterinary Information Network News Service, January 4, 2011)

– “My question is why most vets feel the need to worry about money instead of worrying about taking care of the pets.”

– Although the number of households in the United States with cats is increasing, the number of feline visits to veterinary hospitals is decreasing. (Banfield Pet Hospital® State of Pet Health 2011 Report)

– “I’d love to take each of my cats in for dental cleaning on a regular basis and I have two cats that desperately need attention now. For me, it’s a matter of costs. Vets continue to increase their charges and there’s no break for multiple pets. Dental disease is a precursor for renal failure in cats and yet it’s so expensive for cleaning – yet alone extracting any teeth. Then blood work is usually advisable to be on the safe side. It’s a small fortune when you leave the vet’s office for ONE pet. Next you’ve got the cost associated with monthly flea control. You have to draw the line somewhere and hope for the best.”

– Fifty-four percent of cat owners and 47% of dog owners report that they would take their pet to the veterinary hospital more often if each visit were less expensive. (The Bayer Veterinary Care Usage Study 2011)

– “I am not saying veterinarians can’t charge a reasonable fee for their services, but most people can’t afford $300+ bills every time they step into a clinic, per pet, per year, and that is for the healthy ones who are coming in for regular yearly checkups and not for other medical concerns that require medications, further diagnostics, overnight stays, dental cleaning, blood work etc.”

– Fifty three percent of clients believe that veterinary clinic costs are usually much higher than expected. (The Bayer Veterinary Care Usage Study 2011)

– “I am sick and tired of the way veterinarians financially take advantage of people who are emotionally upset about their pets.”

– Twenty-four percent of pet owners believe that routine checkups are unnecessary and 36% believe that vaccinations are the main reason to take their overtly healthy pet in for an office visit. (The Bayer Veterinary Care Usage Study 2011)

– “We have a lot of price gouging going on here at local vets. A dental cleaning has gone from $75 to $300 and up at many places. A lot of the clinics are buying high tech equipment and passing overhead costs on us so they really shouldn’t complain when clients come for less visits.”

Have you identified the common thread amongst these comments and statistics?  No doubt in my mind that the “gripe du jour” is the “M word.”  Perhaps it is more accurate to say that the real issue is too little money.

This blog is not intended to create or perpetuate harsh judgments. Please hear me when I say that I know that not every veterinarian or every person who brings their pet to see the vet is thinking primarily about money.  Clearly, however, money matters are on the minds of many, in fact more so than I’ve witnessed throughout my thirty year career.   Never before have I observed colleagues declare bankruptcy.  Never before have I spent so much time in the exam room trying to help folks figure out how to do more with less.

My goal in presenting this information is to create some understanding about what’s going on in the minds of individuals on both sides of the exam room table.  Blame this money mess state of mind on the diseased economy, veterinary competition, or the expense of going to veterinary school.  Whatever the causes, there is an awful lot of emotion tangled up in the financial aspects of providing and receiving veterinary health care these days.

What are your thoughts? Let’s talk about it and in doing so we will be able to kick that big ole’ elephant out of the middle of the exam room!

Best wishes for good health,

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Dogs and Mushrooms: A Potentially Lethal Mix

April 1, 2011

Donato © Diana Gerba

     

I remember the sad sinking feeling I experienced last August as I read an email from my friend Diana Gerba.  Seeing her email in my inbox initially prompted excitement- oh goodie, more photos and stories about Donato,  Diana’s adorable Bernese Mountain Dog. My excitement quickly morphed into utter disbelief as Diana described the death of her barely six-month-old pup caused by ingestion of a poisonous mushroom.      

Diana’s heart was broken.  As she wrote in her email,     

A special boy, Donato was a silver tipped puppy, a rarity in our breed. With his tail always wagging, he had boundless enthusiasm for life.  He was a happy little chap and was my joy.  He loved me and I him. We were a team ordained by the stars.      

      

Diana and Donato © Peter Nystrom

Every region of the country is different in terms of mushroom flora. Where I live in northern California, Amanita phalloides (aka Death Cap) is the most common poisonous species and grows year round particularly in soil surrounding oak trees.  Ingestion of a Death Cap mushroom causes liver failure (in people and in dogs)- makes sense given the liver’s function as the “garbage disposal” of the body. Symptoms typically include vomiting, diarrhea, lethargy, loss of appetite, delayed blood clotting, and neurological abnormalities.  Every year at my busy hospital, we see at least a handful of dogs with liver failure clearly caused by mushroom ingestion.  In spite our very best efforts, the individuals who survive mushroom poisoning are few and far between. Affected people can receive a liver transplant; no such technology available (yet) for dogs.      

     

To learn more about poisonous mushrooms visit the North American Mycological Association and Bay Area Mycological Society websites.  If you suspect your dog has ingested a mushroom get to your veterinary clinic or the closest emergency care facility immediately (choose whichever is most quickly accessible).  If possible, take along a sample of the mushroom so it can be professionally identified if need be.     

      

Fortunately, my friend Diana has managed to put a positive spin on the loss of her beloved Donato.  Not only does she have Tesoro, a new little Berner boy in her life, she has made it her personal mission to warn people about the potential hazards of mushroom toxicity in dogs.  She created the attached flyer (see above).  Feel free to download and post it wherever dog loving people congregate.  Diana sent a blast email out just a few days ago after finding a Death Cap mushroom in her yard.   Coincidentally, today I discovered several mushrooms on my property while beginning the task of weeding my garden. They’re gone now, but given our current weather pattern, I’m quite sure there will be more tomorrow.     

What can you do to prevent your dog from ingesting a poisonous mushroom?  Clear any mushrooms from your dog’s immediate surroundings, and be super vigilant on your walks, particularly if you have a pup (youngsters love to put anything and everything in their mouths) or an adult dog who is a known indiscriminate eater.  Learn more about which poisonous mushrooms grow in your area and what they look like.  And please remember, if you see your dog ingest a mushroom- get yourselves to a veterinary hospital as quickly as possible (even if it is after hours). Ingestion of even a nibble of a toxic mushroom is life threatening, and the sooner treatment is started the greater the likelihood of saving your best buddy.     

Are you aware of poisonous mushrooms in your neck of the woods?  If so, please share where you live (city and state) and the name of the mushroom if you happen to know it.     

Best wishes for good health,       

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook       

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.