E-cigarette linked to dog death in the UK

Ivy's legacy: image courtesy of Dogs Trust UK.

SAT readers may be aware that in the UK a staffordshire terrier died following ingestion of a nicotine capsule for an electronic cigarette. E-cigarettes are marketed as a safer alternative to cigarettes, even being used to thwart non-smoking bans, but many critics have raised doubts. 

Nicotine is found in tobacco products like cigarettes, cigars, chewing tobacco, nicotine gum and skin patches, but refills of e-cigarettes are unique in that they contain liquid nicotine.

At low doses, nicotine acts much like a neurotransmitter with stimulant effects on the nervous system and muscle. At higher doses it leads to constant stimulation of receptors in these systems, as well as stimulating the vomiting centre.

It is readily absorbed via mucous membranes, so animals don't even need to swallow (or inhale) to experience toxic effects. Onset of clinical signs may be delayed up to one hour, but in Ivy's case the owner noted salivation and vomiting within 30 seconds of ingestion according to reports. Other clinical signs include bradycardia (slow heart rate), tachycardia (rapid heart rate), tachypnoea (rapid breathing), excitement, agitation, restlessness, muscle fasiculations, seizures, depression, paralysis and death. Affected animals often defecate.

According to reports, Ivy was admitted to a vet within thirty minutes of ingestion, but could not be saved.

In terms of treatment, administration of activated charcoal may be bind toxins in the gastrointestinal tract but is contraindicated in patients that are vomiting. Treatment is supportive and involves intravenous fluids, blood pressure monitoring, sedation, supplemental oxygen and in severe cases mechanical ventilation.

You can access information on nicotine exposure from the British Veterinary Association and Veterinary Poisons Information Service here. 

E-cigarettes and their contents should be treated with the same precautions as household chemicals, being kept well away from children and animals.

It should be pointed out that there is a huge amount of conflict between various reports about many factors that would impact on the severity, management and outcome of this case, ranging from the age of the dogs (in reports she is stated to be anywhere from 12 weeks old to 14 months), the amount of fluid ingested (anything from one drop to an entire vial), timing of arrival at the vet (ten minutes to the following day) and veterinary treatment (activated charcoal and supportive care to steroids). In any case of toxicity, any or all of these factors 

Creating public awareness is of course important in reducing risk to other dogs, but this is a good reminder for veterinarians to report cases of toxicity (in the UK veterinarians are very fortunate to have the Veterinary Poisons Information Service, in the US the ASPCA provides this service) and publish these in the veterinary literature as soon as possible.

Interview with companion animal and wildlife veterinarian Dr Jemima Amery-Gale

Dr Jemima Amery-Gale with an echidna.

SAT caught up with recent graduate Jemima Amery-Gale,a young veterinarian who spends her spare time lobbying for causes she believes in. No matter what your polical persuasion, we think you'll agree that Dr Amery-Gale's energy and committment is inspirational.

She graduated from The University of Melbourne in 2012 and is based at The Ark Vet Hospital in Darwin. 

Tell us a bit about yourself.

I am a new graduate vet and have been working at The Ark since January 2013 (so I’ve been out for a year but still think of myself as a new grad). I am from Adelaide but lived in The Territory for a few years when I was very small, and have now returned to the Top End to work – with the main attraction being the NT’s very special and diverse wildlife. I most enjoy working with wildlife, both at The Ark and The Territory Wildlife Park, but equally love going on bush trips to de-sex and treat dogs in Indigenous communities. I have also been to Timor-Leste twice to work with a team of Australian volunteer vets on livestock vaccination and parasite control programs.

What inspired you to become a veterinarian?

My main passion in life is biodiversity conservation, and I studied veterinary science because I thought it would be a useful skill to have to be able to contribute to the fight to save threatened species from extinction. I suppose my love of animals and passion for preventing the tragedy of species extinction was inspired by my heroes: the naturalist and broadcaster Sir David Attenborough, my mentor and friend, zoologist Dr David Taggart, the wise environmentalist and former Australian Greens leader Dr Bob Brown, and the writings of scientist and climate change activist Dr Tim Flannery. And of course my first hero, dairy farmer and the most generous and kind-hearted humanitarian, my late grandpa Max Gale, OAM.

Looking up at grandpa Max Gale OAM.

You undertook an additional year of research during your veterinary degree. What was this about?

During my Bachelor of Animal Science research year I investigated a gammaherpesvirus and a novel coccidian both infecting the prostate of male Antechinus, plus urogenital tract bacteria of koalas on French Island. Antechinus are small insectivorous Australian marsupials of the family Dasyuridae. They follow the ‘‘big bang breeder’’ pattern of reproduction involving a frenzied two-week mating period in late winter, followed by the stress-related synchronous annual die-off of the entire male population at approximately 11.5 months of age. It is likely that the prostate gland is the site of productive infection for both the gammaherpesvirus and the coccidian, with virus particles and coccidian oocysts being shed in prostatic secretions and hence semen to be cleverly sexually transmitted just prior to the ultimate demise of all host males at the end of their one and only breeding period.

A female antechinus.

My koala work involved searching for mycoplasma as a possible cause of ‘wet-bottom’ (urogenital tract infections) in the chlamydia-free population of koalas on French Island, Victoria. Unfortunately mycoplasmas are extremely fastidious and difficult to culture, so the search proved frustrating and largely fruitless, but did include some fun koala-catching fieldwork on a beautiful island and led to some leads on possible causative bacteria for future projects to investigate.

A koala nurses her offspring in a tree.

Who are the non-human companions in your life right now and how did you come to meet them?

Right now I have 5 delightful chookens and 4 puddle ducks. Their names are Hennifer Anniston, Rose, Martha, Donna, Amy Pond, River Song, Melody Pond, Clara Oswin-Oswald and Madame Pompadour. They are lovely and friendly, tolerate cuddles, make the cutest contented noises and lay me delicious eggs! I love them so much J

Jemima's ducklings and chickens.

What do you do to chill out when you’re not vetting?

Hmm… spend time with family and friends, watch movies, gardening, baking, go to the Darwin markets, listen to music, read, volunteer for a variety of political, environmental and social justice campaigns…

You’re very passionate about politics. What are the main issues you’re concerned about and how do you go about effecting change?

I don’t think I’ve ever been able to effectively effect change, but I’ve attempted to by volunteering for The Greens – I still feel like this is a productive investment of time and effort as our MPs have been able to achieve a lot of positive outcomes in Australian politics, and I feel very proud of our Greens policies. I’ve never felt like I’ve had to compromise my own values to go along with the party position (like I’m sure most major party members have to do with regularity), and even if you put many hours of really hard work (often forcing yourself to be an outgoing campaigner when that doesn’t come naturally) for little statistical gain in the results of an election (like the devastating election of an Abbott-led Coalition at the last federal election), at least I can feel like I was standing up for what really matters and doing everything I possibly could to avert that disastrous result. 

At the moment the main issues I’m concerned about are climate change, our current species extinction crisis, biodiversity conservation and environmental destruction. Plus Closing the Gap and in particular campaigning against the NT Government’s abolition of Bilingual Education for Indigenous kids, campaigning against the Australian Government’s unbelievably cruel immigration policies and the resultant inhumane treatment of refugees seeking our protection, trying to support asylum seekers being held in detention on mainland Australia, reducing global poverty and campaigning against atrocious human rights abuses being committed around the world and most often against Indigenous peoples, particularly in West Papua and Tibet. So in addition to the Greens I volunteer with a few local social justice and conservation groups like DASSAN (Darwin Asylum Seeker Support and Advocacy Network), Territorians for a Free West Papua, Friends of Bilingual Learning and Environment Centre NT, or make donations to contribute to the work of organisations like Oxfam, UNICEF, etc.

What can ordinary vets do to reduce their environmental impact?

Most vets could reduce, reuse and recycle a lot more than they do already, and vet clinics use a lot of electricity – going solar or switching to an alternate source of renewable energy is an excellent way of reducing a clinic’s carbon footprint (plus installing solar panels makes economic sense as it will also reduce electricity costs in the long-term).

Jemima with a patient.

What has been the highlight of your first year in practice? (any lowlights???)

Highlights include fun bush trips to Yuendumu, Nyirripi, Yuelamu, Bonya, Belyuen & town camps round both Alice Springs & Darwin, Milikapiti & Pirlangimpi on Melville Island, & Wurrumiyanga on Bathurst Island working on dog health programs – de-sexing to control dog populations and anti-parasitic treatments to reduce the prevalence and impact of zoonotic diseases to improve both human and animal health and welfare in Indigenous communities. Also working as the relief veterinarian for the Territory Wildlife Park and getting involved in the Australian Wildlife Health Network’s Zoo Based Wildlife Disease Surveillance Pilot Project through the electronic Wildlife Health Information System database. Plus another trip to Timor-Leste with a team of volunteer Australian vets evaluating their pilot livestock vaccination program, and attending 3 amazing conferences: the Sea Turtle Health and Rehabilitation Workshop, the Australian Wildlife Health Network’s Wildlife, Emerging and Emergency Diseases workshop, and the very fun Wildlife 
Disease Association Australasian Section Conference in the Grampians. Also caring for 3 extremely sweet orphaned Sugar Gliders, an orphan Northern Brown Bandicoot and a Radjah Shelduck named ‘Raj’, and getting my first scientific paper accepted by the Journal of Wildlife Diseases. Plus treating a huge variety of interesting Top End wildlife while working at The Ark.

Looking after sugar gliders...someone has to do it!

Lowlights mostly involved getting a few hours sleep on dog mats on the floor of the clinic in between after-hours calls and writing endless boring histories while on-call…

Any tips for surviving your first year out in practice?

Hmm, master the art of being able to say ‘no’ and learn the tricky life lesson of how to be selfish occasionally – strive for that elusive work-life balance…

Thanks Jemima for your time!

What do cats think about animal studies?

Anthrozoology (the study of human-animal interactions) and animal studies are growing areas in academia. What do animals think about that?

This week I recieved a beautiful copy of Max: The Confessions of a Cat, by celebrated Australian poet Antigone Kefala. 

Written in both English and Greek, this is a beautiful book for anyone who loves a) animals b) cats c) animal studies d) poetry e) Greek language f) English language g) beautiful illustrations. 

"People are often complacent and unwilling to let 'other' voices be heard," reads the blurb. 

The protagonist, Max, observes the emergence of new theoreticians and animal rights theorists.

I must admit that in spite of all this, the equation seems constantly to favour humans, it carries their point of view. We must all take to writing, this is the only way. Tell our stories...do our analysis, present the CAT'S point of view. Maybe, as some friends are suggesting, I should take to oral history, interview some CATS, see what they have to say, directly, their lives, experiences, their difficulties and so on, this may prove interesting.

Indeed. Max's confessions are delightful, wry, thought-provoking and lovely to read.

Meanwhile on the internet this week, an unlikely friendship between Roo, a two-legged chihuahua who uses a wheelchair, and Penny the chicken, both rescued by Duluth Animal Hospital, has been featuring prominently. One worries that these "unlikely friendships" are PR stunts, but in this case there seem to be plenty of unposed photos that suggest it is a genuine bond.

On a more serious note, Worms and Germs blogger Scott Weese has pointed out some quarantine issues re the adoption of puppies on Sochi by Olympians and others. You can read his post here. When adopting any animal, but especially from another country, it is essential to consider quarantine, both for any official requirements but also to protect animals in the community.

Need for public policy changes around pets: Liz Walker, Lort Smith Animal Hospital

Everything a girl needs: comfy couch, pink outfit, soccer ball and a blanky. Jessie lives it up bigtime!

We were contacted last week by a lovely gent named Bruce, who together with his wife has owned Cavalier King Charles Spaniels since the 1970s. Having retired and decided that it is time to downsize, Bruce is seeking to move into a retirement village but has been told that they can't bring their dog (whose family they have bred for generations) with them. He's done a lot of research, and sought advice from everyone including the Minister for Fair Trading (pending).

Unfortunately, Bruce is not alone. Many people find themselves in this position. This week, Lort Smith Animal Hospital CEO Liz Walker stepped up on behalf of pet owners to declare that we need to consider changes in public policy around pet ownership, in particular the need for more pet-friendly accommodation.

Walker, a veterinarian and animal lover, says that companion animals are a "lifeline to happiness" for many, and puts forth a powerful case. And for landlords who aren't keen for tenants with pets, she has some advice:

Animal people are mostly really great people and know how to look after a property. There are just as many dills who don't look after a property, and don't know how to look after a property, who don't have an animal. Pet ownership is not a proxy for destruction.

You can read the full article in The Age here.

Another fluffy blanket from Jessie's awesome collection. 

Bruce, we're thinking of you and your family. Meantime, we'd like to thank Jessie and Rae-anne for these stunning photos.

SAT has posted on the need for pet-friendly accommodation and pet-friendly aged care before, and we salute those who are working hard to create awareness and positive change around this issue. You can read interviews with some of them here:

Interview with Dr Emma Power 
Interview with Di Johnstone
Interview with Jan Phillips

This week's pet and animal related links

Forbidden furniture...its SOOOOOO good.

US Winter Olympian Gus Kenworthy is winning hearts and twitter followers around the world by drawing attention to the stray dog problem in Sochi - and doing something about it: not only is he bending the ears and cameras of any journo who wants to listen, the skier is also planning to adopt some. Clearly there will be some quarantine issues to sort out, but we're impressed with his personal committment. 

There has been much debate, as there should be, about the culling of "surplus" giraffe Marius at Copenhagen Zoo. Sydney Uni Human Animal Research Network (HARN) associate Dr Matthew Chrulew did some interviews last week on the topic. He has done some important research on the culture and practice of zoos and wrote a chapter in Animal Death on the topic. You can read and listen to his interviews with the Sydney Morning Herald here and on Sunrise here. (Its a shame that the latter interview cuts off when the host asks a great big philosophical question at the end...I was left hanging on the edge of my seat!).

Speaking of HARN, you can watch the recent presentations in the comfort of your own home on the HARN vimeo channel which has just been updated. Check it out here. Its a great way to stay current with some excellent research in the animal studies area.

Visit Lili Chin at http://doggiedrawings.net/

Artist Lili Chin and Design Lab Creative Studio created this fantastic poster on the World's Most Dangerous Foods for Dogs. You can download it here. They've done a great job summarising some of the key food hazards (I have to tell clients every day to avoid feeding grapes to their dogs. For some reason, dogs do love them...but they can cause severe toxicity and death, so it isn't worth the risk).

This clip, released a couple of years ago now, is hard not to re-watch. It combines two of our favourite things: ABBA and enthusiastic, positive animal lovers. I don't know how many takes they did, but it was worth it.

Things I learned: mast cell tumours

A mast cell tumour, clipped prior to surgical resection.

Mast cell tumours (aka mastocytomas, histocytic mastocytomas or mast cell sarcomas, we call them MCTs) are commonly seen in companion animal practice. Recently I attended a webinar by oncologist Dr Sandra Nguyen about MCTS, which provided a fantastic review. Veterinarians can log in to the Vet's Australia website to view the whole thing.

MCTs occur in all breeds, but boxers, pugs, bulldogs, bull terriers, Labradors and Shar-Peis are over-represented (most vets who attended agreed that in Australia at least, Staffordshire terriers are commonly affected although this predisposition isn't documented in the published literature). Boxers and pugs tend to have lower grade MCTs while Shar-Peis have the more biologically high-grade types.

MCTs are very common. Between 6 and 21% of skin tumours in dogs are MCTs, and these account for 25 per cent of malignant skin tumours. On presentation, 14 per cent of affected dogs have more than 1. Most occur in dogs over the age of 8 but some recorded in dogs as early as three weeks old!

MCTs located on the prepuce, perineum, inguinal region and muzzle tend to be more malignant.

Chronic inflammatory skin disease may predispose dogs. A mutation of c-KIT, a receptor for stem cell factor, is present in around 40 per cent of MCTs and is therefore a potential therapeutic target (a test for c-KIT mutation is available through Colorado State University).

The most common location for MCTs in the dog is the skin (in the cat it’s the spleen).

Mast cells contain heparin, histamine, eosinophilic chemotactic factor, proteolytic enzymes and serotonin. Thus for example heparin causes local haemorrhage at the tumour removal site, histamine release causes inflammation, proteolytic enzymes may be responsible for the “squooshy” feel of MCTs (often leading them to be mistaken for lipomas) etc.

FNA is highly sensitive (although can be misleading or non-diagnostic), but biopsy is needed to grade the tumour which is helpful for prognostication and treatment planning. Additionally, Diffquick stains may not show intracytoplasmic granules so while you may be able to get to diagnosis of a round cell tumour on cytology you might need to send out slides for a Giemsa stain.

Staging is recommended for Grade II MCTS and above. This involves aspiration of regional lymph nodes (MCTs usually metastasize to the lymph nodes first); abdominal ultrasound (especially focusing on the spleen, liver and lymph nodes); complete blood count; thoracic radiographs and, in dogs with an abnormal haemogram – eg neutrophilia, monocytosis, eosinophilia, basophilia, anaemia or thromocytopaenia) – bone marrow aspirate may be performed.

MCTs rarely metastasize to the lung.

Treatment usually involves radiotherapy or chemotherapy (prednisolone with vinblastine or CCNU +/- tyrosine kinase inhibitors). Prednisolone has been used for pallation as a monotherapy.

Tyrosine kinase inhibitors inhibit c-KIT, the stem cell factor that is overexpressed in MCTs. They can also inhibit angiogenesis by targeting vascular endothelial growth factor (VEGF) and platelet-derived growth factor.

According to Dr Nguyen, these are indicated with grade III or higher MCTs with a mitotic index of over 5, or metastatic low grade tumours.

Her protocol involves administration three times a week (eg Monday, Wednesday and Friday) at a dose of 2.5mg/kg. Steroids or NSAIDs can be used on the off-day.

Complications of treatment with tyrosine kinase inhibitors include GI ulceration (treat with sucralfate), diarrhoea (use metronidazole), proteinuria or hypertension (use benazepril or enalapril), neutropaenia or hepatoxocity (a break from the drug is usually enough).