Pet Poisonings: the Unexpected

Aren't those pictures great? My thanks to Dr. Clarke Atkins for sharing his travel postcards from Africa. 

The holiday season is upon all of us. Families and their guests get busy with festivities, traveling, and cooking. Guests often leave opened suitcases and exposure to a variety of substances. Unexpectedly, a family pet starts showing unusual signs: vomiting, diarrhea, depression, hyperactivity, and even seizures. The common question is “now what?" I thought this might be a good time to go back and look at the emergency contact numbers for poison control – the first step – and contacting your veterinarian or emergency veterinary hospital. 

WHAT ARE THE EMERGENCY PET POISONING HOT LINE NUMBERS? Note both have a fee

ASPCA is 888-426-4435

Pet Poison Hot Line is 800-213-6680 (check out the iphone app) www.petpoisonhelpline.com

There is a Pet Poison Help on iTunes for $1.99



WHAT ARE THE MOST COMMON POISONINGS?

This time of year it is human food that is toxic to pets (dark chocolate, xylitol sweetened products, raisins, macadamia nuts, garlic, onions, raw-yeast dough, and grapes), garbage can stuff, and human meds.

SINCE WE ARE TALKING ABOUT HUMAN MEDICATIONS WHICH ARE THE MOST WIDELY REPORTED OF CONCERN TO VETERINARY POISON CENTERS?

1. NSAIDs - ibuprofen pain medication (e.g., Advil and some types of Motrin) and naproxen (e.g., Aleve). **may develop serious gastro –intestinal ulcers as well as kidney failure.

2. Acetaminophen—(e.g., Tylenol for pain) is popular. While approved for dogs’ pain (though not very effective) one regular tablet to cats may lead to red blood cell destruction (limiting their ability to carry oxygen) and liver failure.

3. Antidepressants (e.g., Effexor, Cymbalta, Prozac, Lexapro)— can lead to sedation, incoordination, tremors and seizures. Other forms of these medications may lead to elevated heart rate, blood pressure, and body temperature. Cats seem to enjoy the taste of Effexor.

4. ADD and ADHD medications (e.g., Concerta, Adderall, Ritalin)— contain potent stimulants such as amphetamines and methylphenidate. ** can cause life-threatening tremors, seizures, elevated body temperatures, and heart problems.

5. Benzodiazepines and sleep aids (e.g., Xanax, Klonopin, Ambien, Lunesta)— About half of dogs that ingest sleep aids become agitated instead of sedate. In other pets may see severe lethargy, incoordination (including walking “drunk”), and decreased breathing. In cats, some forms of benzodiazepines (think valium) can cause liver failure when ingested.

6. Birth control (e.g., estrogen, estradiol, progesterone)— small ingestions typically do not cause trouble. However, large ingestions can cause bone marrow suppression and irreversible anemia.

7. Ace Inhibitors (e.g., Zestril, Altace)—Angiotensin-converting enzyme (ACE) inhibitors are commonly used to treat high blood pressure in people and, occasionally, pets. Overdoses can cause low blood pressure, dizziness, and weakness..

8. Beta-blockers (e.g., Tenormin, Toprol, Coreg)—Beta-blockers are also used to treat high blood pressure but, unlike with ACE inhibitors, small ingestions of these drugs may cause serious poisoning in pets. Overdoses can cause life-threatening decreases in blood pressure and heart rate.

9. Thyroid hormones (e.g., Armour desiccated thyroid, Synthroid)—luckily, the dose of thyroid hormone needed to treat low thyroid in dogs is much higher than a person’s dose. However, large overdoses in cats and dogs can cause muscle tremors, nervousness, panting, a rapid heart rate, and aggression.

10. Cholesterol lowering agents (e.g., Lipitor, Zocor, Crestor)— most statin ingestions only cause mild vomiting or diarrhea. Serious side effects from these drugs come with long-term use, not one-time ingestions.


What is the concern about dietary supplements and vitamins in opened suitcases of guests and risk to pets?

Although Vitamins C, K, and E are pretty safe, those of concern include iron, vitamin D, and alpha-lipoic acid when consumed in overdose situations. This is compounded by the artificial sweetener xylitol that is contained in sugar-free vitamins and is very toxic to pets.

What should you do if you think your pet is poisoned?
1. Remove your pet from the area. Make sure no other pets or children are exposed to the area, and safely remove any poisonous material.

2. Collect a sample of the material, along with the packaging, vial, or container for documentation.

3. Don’t induce vomiting or administer milk, food, salt, oil, hydrogen peroxide* or any other home remedies unless instructed by professional advice. *do not use in cats


Betsy Sigmon DVM, Diplomate ABVP canine and feline

Creature Comforts Animal Hospital



Cary, NC

Intestinal Foreign Body: A sock is missing

Like any other pet owner, I recently had that morning episode where there is vomit and bowel movements all over the laundry room with no apparent cause. Trying to get ready for work, I quickly reflected on the prior 24 hours (any new foods, trash cans, stuff missing, exposure to other dogs). Hoping to ignore the obvious, I walked my dog, Taco Belle, outdoors and noted the bodily functions to confirm the evidence noted back in the house. So what is a pet owner to do? Should you go to work, drop the pet off at a veterinary office, or simply offer supportive care until a recheck at lunch time? 

Well, since I own the business and I am a veterinarian (Yes, my friends say Taco Belle is lucky to have her own personal doctor), she went to work with me. Fortunately, after a battery of tests including radiographs, Taco Belle recovered after 36 hours of supportive care. 

Realistically, that is not the same for my clients. Thus an overview of steps follows. 

What are some basic principles for a pet with an upset stomach?

Search the house and see if any trash cans are invaded (bones, grease), cabinets open to poisons, yard/rat bait exposure, anything shredded (fabric, thread, balls) and laundry (socks, hand towels, and underwear L missing). If something is of a concern, call the Creature Comforts office for further instructions. I once had a dog eat approximately one pound of pea gravel where grease from a grill had been discarded so search well! 

If nothing is noted, take up food, give some ice cubes, and monitor for frequency of diarrhea/vomiting or both. If having three or more of each in a four to six hour period, call for additional instructions. If no vomiting for three hours, give a trial of Pepto-Bismol liquid (87mg/ tsp) at ½ to 1 tsp ( 2 to 5 mls per 10lbs) twice  a day for 3 days. If using the tablets, that would be around ¼ of the 262 mg tablets per 10 lbs. of body weight. 

Is there a home diet to fix?

Typically some poultry broth ( assuming no food allergy) may be provided after three to four hours, followed by one part of a meat to two parts of a starch (such as potato) at a rate of 1 cup per 10 lbs. a day. 

At Creature Comforts, what are some of the more common GI emergencies?

Continuous vomiting, lack of appetite, and diarrhea (often bloody) lasting over four to six hours are frequent client concerns. In addition, suspicious exposure to a toxin (chocolate, yard treatments) and a possible foreign body are the most common emergencies.  In large, deep-chested dogs such as Great Danes, twisting of the stomach (Gastric dilatation and volvulus) is a life threatening emergency. 

What is a linear foreign body/ obstructions?

It is a blockage created by eating thread or dental floss (very common in cats) and in dogs more commonly a sock/knee highs or a strip of towel, fabric, or carpeting. Most of these do not completely block the intestines. Rather they gather (fixed at one point) and pleat the intestine (think the shape of an accordion) causing a partial to complete obstruction. IN ADDITION, the object cuts into the wall of the intestine leading in many cases to a life-threatening perforation of the bowel.  Although vomiting is seen in many patients with linear foreign bodies, often the pets exhibit only anorexia or depression (depending on where the object is lodged). Radiographs, ultrasound, and ultimately surgery is needed in such circumstances as the object if often too far down into the bowels of the intestine to induce vomiting. 

Once things settle down, what do you use to clean carpeting?

I blot up the excess, throw away as much of the solid material as possible, and then use Nature’s Miracle available at most major pet retailers.

This is a picture of my son Jason when he was 3 years old and then today in Hong Kong.

Happy Thanksgiving to you and your family

Betsy Sigmon DVM, Diplomate ABVP, canine and feline

Creature Comforts Animal Hospital

Cary, NC

PET FOOD LABELING, PART 2

                                                

Continuing the blog from last week, I share my own experience in reading food labels on my own cookie favorite, Vanilla Oreos. In a quick glance, three cookies have 170 calories. That is a mid-day treat for me, when time allows. However, in a quick change of allegiance, I noted the lemon flavored Oreos had only 150 calories. Or so I thought.  As a reward for a calm moment the next day I sat down to eat the little treasures and surveyed the back panel. Well, much to my surprise, now my allotment was 2 cookies! Yes, great marketing that appeared to have less calories, and I am down 1 cookie. The point –  I did not read the label carefully and was fooled. This got me thinking. In the 5 seconds that the average pet owner spends to select a pet product, how many flip to the pack panel?

What are some tricks in reading dog food labels?

I remember the Consumer Reports article years ago that had a dog food where shoe leather was the main ingredient. For many consumers, the percent of protein is the gold standard. However, that number does NOT reflect digestibility and bioavailability of that protein to a dog.

The second trick is the word minimum. For example the 4% fiber minimum on a can is non digestible. So the true fiber content could be much higher.

Finally, ingredients are listed in descending order of quantity with often minute amounts of human attractive foods such as “blueberries." To sort it out, find the sodium chloride (or equivalent salt) in the list, and all over ingredients listed behind it are 1% or less.

Is there a quick questionnaire to ask the manufacturer to establish is it a balanced diet?

Yes, ask who formulates the diet and do they have one of the following on staff: board certified nutritionist or PhD nutritionist.

Are they available for consultations?

Do they perform in house feeding trials?

Where is it manufactured and is it contracted out?

Is complete nutritional analysis available?

Is there research on the product published in peer reviewed journals?

Where is the documentation that the marketing materials stated on the label are based on sound science and have an industry standard meaning? (Ex. Healthy weight)

Are there some independent sites to check out common varieties of pet food for calories, etc?

The Association for Pet Obesity,  www. Dog food Analysis.com , and the Truth About pet food.   Note the site “Pet Food Advisor” is written by a human dentist, not a veterinary nutritionist.

How does a pet owner search out meaning of terms in pet food?

Words such as meat, by-products, dinner, supper, with flavor, chicken meal, and fish meal, for example, all have special meaning defined by the American Association of Feed Control Officials (AAFCO). . Chicken meal is actually the spine and ribs of the carcass ground up fine (and less digestible than the by-products). It is NOT the chicken breast in human chicken salad as marketers would have portrayed.

What is Organic pet food?

 There is no data to back that organic is healthier, nor does it refer to the quality of the raw material. It is a verb that describes the process under which the plants or animals are grown or raised.  

What is natural?

It means solely from a plant, animal, or mined source not having been chemically synthesized, except trace minerals or vitamins.

What is the industry standard on how much to feed a dog?

The standard is for an intact Beagle; yet, when neutered the metabolism is 30% less. Therefore feeding guidelines on pet food bags typically overestimate by 30%.

What are human or holistic grade pet foods?

There is no such term defined by AAFCO so it is a marketing term that is baseless. 

What guidelines are established for the acquired textures of pet food for small dogs and cats?

 They are texture driven, not taste driven (only 500 taste buds). They do not like: the crumbly pieces in the mouth after biting into a hard kibble (think teddy graham when you crunch on it).  In summary small dogs over all prefer soft and cats often like the x shaped kibble.  

Will dental diets get rid of hard tartar on the teeth as a treatment?

Dental diets work as a preventative, not a jack hammer once tartar is present

When my pet during an office visit is given a body score of 6 (1 to 9 scale) what does that mean?

So if ideal is a 5 , and your pet is  labeled a 6, then each even number is 10% over with so for a 50 lb dog that would be if 55 lbs. want to get to 50.

Is there a site to calculate human treats to more accurately determine my pet’s total calories in addition to the pet food consumed?

Yes, http://ndb.nal.usda.gov/

What is the basic calculation that is utilized on adult pets to determine their caloric needs for weight loss?

To calculate ideal weight go to metabolic formula 70 x body wt.  in kg to the 0.75 power will be the caloric intake. Some start with current amount x 0.8 and others go straight to ideal weight and calculate it.

Last week I mentioned Erik Axelsson’s work at an evolutionary geneticist at Uppsala University in Sweden to separate wolf from dog diets  as domestic  dogs evolved around human garbage dumps. A similar link is noted in http://www.wired.com/2014/11/genes-cat-domestication/ on how cats evolved around people.

 I am grateful to Helen Poe sharing her picture of her Dalmatian, Wiggins,  and this photo of Sadie, a golden Retriever shared by Terri Rice 

Betsy Sigmon DVM, Diplomate ABVP Canine and Feline

Hospital Director, Creature Comforts Animal Hospital

Cary, NC

Pet food Labeling: sorting out the facts, PART 1

While attending a continuing education meeting in Nashville, Tennessee this weekend, I took some time to visit the Country Music Museum  and enjoy some good "eats".

It was interesting to see a convertible with pistols for door openers, a machine gun on the trunk, and long horn ornament on front of car for Web Pierce.  Elvis Presley’s 1960 Cadillac Limo with gold plating of mirrors and portable TV was a MUST See.  

Clients frequently express their frustrating experience sorting through the maze of selecting a diet for pets. The average time spent in the pet food aisle is approximately 5 minutes.  However, there are hundreds of choices out there to cater to every dog owner’s taste – organic kibbles to generic nuggets. Therefore, the marketing appeal of the “front of the bag” often is in contrast with the flaws detected on the back panel. In fact, for many packages or cans, it is a challenge to interpret the ingredients or the actual calories.  More telling is the emotional fervor, like political or religious affiliation, that some clients are adamant about feeding commercial, home cooked, or raw diets. For those reasons, I have skirted this issue in prior blogs. In an honest discussion to separate some fact from fiction, I will present some of the pearls discussed.

Since dogs are descendants of wolves and evolved in the wild, should they not eat a predominately meat diet? What about cats?

Dogs, unlike wolves, as they became more social actually evolved around garbage dumps adapting to the starchy, plant based diets of people. Thus, their digestive tract adapted to eating carbohydrates found in grains and vegetables. Compared to wolves, these ancestral dogs had higher survival rates and were the parent stock of dogs of today. This is a key difference from wolves as they lack many of the key glucose transporters so they are less efficient in digesting carbohydrates. Dogs are omnivores (eat meat and plants), while cats are carnivores and thus must have a meat based diet.  

Are there any quick formulas to analyzing protein & fat  pet food labels to compare wet to dry food with extreme differences in moisture content(as fed) to a dry matter basis to compare “apples to apples”?

Although not fool proof, a multiplier of wet food by 1.1 and dry food by 4x’s will get the protein and fat content pretty close.

I have read on the Internet that grain-free is better. Yet I read on many grain free package ingredients such as oats and flax seed. Aren't those grains? What is the truth about grain free?

The body does not treat grains differently from potatoes, peas, tapioca, or other starch sources; rather the body simply recognizes the nutrients it contains. Contrary to marketing claims, dogs and cats have the enzymes to effectively digest the grain starches that are highly digestible in most breeds. In addition, grains are not fillers; rather they contain protein and many important vitamins and minerals. While some grain free diets provide excellent nutrition, they have no inherent nutritional advantages over diets that have grains.

Are grains a common cause of food allergies?

Since food allergies are a reaction of the immune system to certain proteins, they are actually quite rare to grain. Food intolerance demonstrated by intestinal signs (vomiting or diarrhea) are more likely related to meat (beef, dairy, chicken, egg) in the diet or excessive fat. There are 2 breeds – Irish Setters and soft coated Wheaton terriers – that seem to have some wheat sensitivity.  

What concerns are noted about weight gain with grain free diets?

Many are low in fiber and high in and fats. They are easy to overfeed as the low fiber does not tend to “fill up animals”. Many of the highest calorie pet foods are labeled as grain free. Note: The jury is still out on what is “grain free” as many contain oats and barley that are considered grains by independent thinkers. Any diet high in calories can lead to obesity.

A GOOD REFERENCE OF ANSWERING PET FOOD QUESTIONS IS DR. LISA FREEMAN, A VETERINARY NUTRITIONIST AT TUFTS AND HER ARTICLEWWW.DCAVM.ORG/11MAYNOTES.PDF

It was a cold weekend so My dog Taco Belle headed for the blankets!

Betsy Sigmon DVM, Diplomate ABVP, Canine & Feline

Creature Comforts Animal Hospital

Cary, NC