Your Dog Ate Weed: Interview with singer-songwriter and vet tech Kelsey Carpenter

Kelsey and Birdie.

Kelsey Carpenter is a veterinary technician and also talented singer-songwriter. She exploded into my life early this week when someone forwarded a You Tube video of a girl singing her own song, “Your Dog Ate Weed” - a clinical scenario many of us are familiar with. Since then I've found myself humming “All we wanna know, is how much, how long ago...”. The internet superstar had some time to spare to share her story with SAT. But first, here's the tune.

 

What is your day job?

I work as an RVT and lead technician at a 24 hour emergency hospital in Los Altos, California.

How long have you been singing?

I grew up singing, but it wasn’t until college that I worked up the courage to sing in front of anyone!

What was the inspiration for your song?

I started out by writing the “Happy Tech Week” song because I wanted to say thank you to all of my amazing coworkers, and thought a musical number would be a fun (and unexpected) way to go about it. I was blown away when that song received so much attention! All types of people were asking when I would be posting another song, and so I just had to do it to say thank you for all of the support I received!

What do you hope people will take away from it?

THC toxicity is always a tricky case. It can be uncomfortable to ask clients about possible marijuana exposure, and it can be just as uncomfortable for clients to come clean (no pun intended). I hope that my song can lighten things up a little for everyone and make it a more broachable subject. Our pets cannot talk (still waiting on that technology), so accurate and efficient communication between pet owners and veterinary professionals is key! THC toxicity itself is no laughing matter, but if people can laugh at my silly song, then maybe they will remember the message behind it - that we all just want what is best for the animal, and that honesty is always the best policy when it comes to medicine!

Any other veterinary themed songs you are working on?

The experience of posting these songs has taught me just what a close knit and supportive community we have in the veterinary industry! The positive feedback I have received from both close friends and complete strangers has definitely motivated me to put out some more songs. I have been getting some great requests, too, so definitely stay tuned! 

Do you live with any non human animals?

My roommate is a 6 pound Chihuahua mix named Birdie. She never pays rent on time and has no concept of personal space. She’s lucky she’s cute.

Can you tell us how you met?

I was working with a rescue group in Los Angeles several years ago and stopped by the East LA shelter to pick up some paperwork for them. You know how people say their pets chose them? Well I really have no other way to explain it! She was in a cage with at least 10 other small dogs, but as I walked by, she pushed her way to the front like “Stand back, guys. This one’s mine.” And I must say, I feel pretty darn lucky to be “The Chosen One”. :)

Is there anything you’d like to share with veterinarians and future veterinarians?

I have so much respect for the people who work in this field. This job is incredibly tolling physically, mentally, emotionally, even socially. In my experience, humor has been one of the few ways I’ve been able to process the many difficult situations I encounter as a veterinary technician. It is actually unbelievable to me the capacity each of us has for sadness, fear, pain, and heartache, and does not always surprise me that so many of us combat things like compassion fatigue, depression, and burnout at some point in our careers. It is crucial we all find a way to “decompress” after particularly difficult shifts, or else we run the risk of suffering from the “emotional bends”. Creating this music has been a wonderful way for me to process things for myself, and I hope that these songs can help others find something to laugh about as they “decompress” as well.

Thanks Kelsey for taking the time out of your schedule. I cannot wait for your first album - veterinary practice just has so much raw material.

Beware: pets and topical medications

Did you know topical medications for humans can be toxic to pets? Cats in particular may groom these products off themselves or their owners.

Are you careful to protect your pets against accidental exposure when you apply medicated creams to yourself or family members?

The US based Food and Drug Administration (FDA) recently warned pet owners of risks associated with topical painmedications containing the NSAID flurbiprofen.

The FDA issued the warning after receiving reports of probable flurbiprofen toxicity in cats in two households where the owners used these preparations on themselves to treat pain. In the affected households, the owners applied the cream or lotion on their own neck or feet.

While it is not known how the cats were exposed to the medication there are a couple of possibilities. The drug may have been groomed directly off the owner, or the owner’s clothing or bed-linnn. Alternatively it may have been indirectly exposed to the cats’ fur when they sat on or near the owner, or on or near objects that had been in contact with the owner’s treated body parts, then groomed the drug off themselves. Or it may have been absorbed through the skin.

In addition to flurbiprofen the products implicated contain muscle relaxants (cyclobenzaprine and baclofen) and analgesics (gabapentin, lidocaine or prilocaine). Flurbiprofen is used in eye preparations for companion animals in some countries, but at very low concentrations. The concentrations on the topical product used to treat muscle pain in humans are much, much higher.

In one household two cats developed renal failure and recovered with treatment. Somehow this was associated with the flurbiprofen as the FDA included this in the alert.

In another household, two cats died after showing signs including inappetence, lethargy, vomiting, melena (black, tarry stools), anaemia and dilute urine – consistent with renal failure. A third cat died after the owner had ceased using the medication – although it’s not known if this was delayed onset or due to ongoing exposure by some route. Necropsies showed evidence of renal and gastrointestinal pathology that were consistent with NSAID toxicity. Pretty devastating for these owners.

The FDA has provided thefollowing consumer advice for uses of topical pain medications containing flurbiprofen, but this is good advice to follow in general when it comes to topical medications.

This is not the first time topical preparations for humans have been implicated in companion animal fatalities. Minoxidil, the active ingredient in a hair growth promotor, has been associated with fatal acute heart failure in cats. Diclofenac gel which is commonly used in humans is also toxic to companion animals.

Always wash your hands after applying topical preparations, don’t let your pets groom you after applying any sort of topical preparation, and avoid leaving residues on clothing and furniture.

Remember that companion animals are not small humans. What is an appropriate dose of a drug in a human might be a highly toxic dose in an animal.

Book review: The Dose Makes the Poison

When I started reading "The Dose Makes the Poison" in the bath, Hero decided it was a very good time to tap on the window.

When that didn't elicit a response, he got a bit vocal.

And roared like a wild beast. It was a VERY short bath.

Can a chemical be good or bad? Is natural better than synthetic? These are important questions raised and addressed in The Dose Makes the Poison: APlain-Language Guide to Toxicology.

The book addresses common concerns about chemicals and drugs, stressing that toxicity is relative and depends on the context. Take anything in a high enough dose and it can kill you. Even water (see this case report, for example).

As the authors state,

“The toxic effects of a given chemical depend on dose (how much), frequency of exposure (how often), and the route by which the chemical enters the body. It always has been thus, and there is no reason to believe it will ever be otherwise. Yet some people find it difficult to believe that chemicals follow any rules at all.”

The book challenges fears about chemicals and drugs, providing useful and very accessible information about what chemicals are, what harm they can cause, what toxicology is, how toxicology studies are conducted and factors that influence the toxic effects of chemicals (such as route of administration, metabolism, excretion and individual factors like gender, age, health and nutritional status of humans and animals exposed). 

It includes some fascinating history, including details about early toxicologists Paracelsus and Ramazzini. (The former refused to be a hoity-toity academic and hung out with labourers, Gypsies and other types avoided by genteel folk, and was killed due to wounds sustained in a pub brawl at the age of 48; the latter specialised in epidemiology and wrote an early textbook on occupational diseases. He hung out with those he wrote about – visiting workplaces like mines, factories and cesspools to experience the conditions in which people worked, and argued for better working conditions).

The book provides an excellent introduction to toxicology and addresses a lot of common concerns about risks associated with chemical and drug exposure. It challenges the concept that “natural” chemicals are “good” and “synthetic” chemicals are “bad”.

There are some minor factual errors, such as the comment that horses are unique in their inability to vomit (there are a few other species that can’t vomit, such as rabbits) and a bold statement that no one ever overdosed on liver (they have, and it can lead to vitamin A toxicity which is one reason for limiting liver in the diet).

The ethical implications of toxicology studies, though raised, could have been explored a little further, particularly around the subject of animal use and alternatives. Given the millions of animals used in toxicology studies, this is a major animal welfare issue with scope for massive reduction in suffering.

Nonetheless, the overall aims of the book are noble: to inform people how toxicology is studied, explaining its limitations, and encourage them to be informed consumers of the literature.

A good book for general readers with an interest in science, anyone interested in toxicology, pharmacology, chemicals or poisons.

Reference

Frank P & Ottoboni MA (2011) The Dose Makes the Poison: A Plain-Language Guide to Toxicology (3^rd edition). John Wiley & Sons, New Jersey.

Leisure sickness, vultures and dog genetics

Dogs don't seem to suffer from leisure sickness. At least I've never been asked to treat one!

It’s that time of year when everyone goes on holidays. Well, lots of people. Well, possibly many of us are working. But we’re TOLD it’s the holiday season, which can be enough to trigger “leisure sickness” – you know, that awful cold/flu/bug you get when you slow down for a moment and contemplate enjoying an unstructured day.

For those of you staring down the barrel of an xmas/new year break and feeling your blood pressure rise, you aren’t alone. Leisure sickness is a thing, according to James Adonis writing for the Sydney Morning Herald.

You can read the full article here (although a warning, the barbaric – as noted - experiment on monkeys cited in this case doesn’t support the argument at all, and if anything demonstrates how pointless such experiments are. Yes, signs of disease and stress-related illness can have delayed onset – these animals were certainly not subjected to working conditions, nor holiday conditions, and such poor science should not be legitimised with citation).

This vulture, photographed at a zoo overseas, is safe from diclofenac but has to deal with poor husbandry.

Meanwhile the EuropeanMedicines Agency (EMA) has again raised concerns about the use of an anti-inflammatory drug in livestock. Diclofenac, used as an anti-inflammatory and analgesic (and marketed in Australia as voltaren), is used in livestock in many countries. It’s one of a number of drugs that can have adverse effects not just on the animals it is administered to directly, but others as well.

When vultures and other bird species that consume carcases (necrophagous birds – new word for the day) eat carcases containing diclofenac residues, they can die (due to kidney failure).

According to the EMA, the drug is associated with the rapid decline of vulture populations. Veterinary medicines containing diclofenac have been banned in some Southeast Asian countries. The EMA’s Committee for Medicinal Products for Veterinary Use (CVMP) released a report about the problem, which you can read in full here.

Finally, if you’re genetically minded you might enjoy Jessica Hekman’s post on some of the perils of breeding dogs (read here).

She was asked to expand on some comments she made (esp about Golden retrievers) by the Huffington Post (read here).

Enjoy the weekend, folks – and avoid the leisure sickness.

Great news for cats: Bob Martin permethrin-containing flea products to be removed from UK supermarket shelves

A victory for cats: Bob Martin gets behind call for reclassification of permethrin-containing products, which are potentially toxic to cats.

We’re taking a brief break from this week’s zoonoses and infectious disease them to share the big news that petcare brand Bob Martin has announced it will remove permethrin-containing flea products from supermarket shelves.

The reason for doing so – and this decision wasn’t made without the benefit of some long-term, large-scale lobbying – is to reduce misuse (i.e. application of the dog flea product to cats which can result in death of cats).

Permethrin toxicity remains one of the most COMMON feline toxicities worldwide.

This change has taken many, many years to come about – thanks to campaigns from around the world including the latest by International Cat Care to get products in the UK reclassified so that pet owners have to receive verbal advice at the point of sale about use ofthe products.

According to this report, Georgina Martin said:

"We have decided to reclassify our permethrin-containing on-animal flea treatments to pharmacy-only and call for a change in licensing by the Veterinary Medicines Directorate so that they may only be purchased if advice is given about their correct use," she said. "This is the next step in our journey as a responsible business, having already voluntarily withdrawn permethrin dog spot-ons a few years ago, which we replaced with fipronil – the same active as used in leading spot-on treatments from the vet."

As many SAT readers will know, we've been lobbying downunder for change as well, meeting with supermarkets, manufacturers of products, and regulating bodies. But there is much resistance to change - even when it may save lives. You can find out more in our previous post here. And if you're in any doubt that permethrin is responsible for feline morbidity and mortality, you might want to read this paper. Restricted access, really, is a no-brainer - particularly when they are plenty of alternatives available, not just fipronil.

Malik R, Ward MP, Seavers A, Fawcett A, Bell E, Govendir M and Page S (2010) Permethrin spot-on intoxication of cats – literature review and survey of veterinary practitioners in Australia. Journal of Feline Medicine and Surgery 12(1):5-14.

If you’re interested in animal welfare you might want to enrol in Pauleen Bennett’s course through the Centre for Veterinary Education. It’s all online, so you can do it from anywhere in the world. Click here for more information.

And if you’d like to read more about Pauleen Bennett, check out this post on anthrozoology here.

Thank you, keen readers, for the ongoing stream of small animal links. Rachel, again, gets a nod for this footage of an armadillo playing with a toy pig. This is the kind of video that justifies the entire existence of the internet (aside from SAT of course!!!).

And then Deb chipped in with this tear-jerker compilation of good news compiled by Animals Australia.

If you need even more distracting, you can always follow this link on dogs sitting in unusual places. 

Black whipsnake envenomation in dogs

Molly the day she presented with a black whipsnake bite (note bite on her right arm). The bandage is to hold the IV line in place. The two-toned style was because we ran out of blue so had to add pink. We weren't being fancy with the dressing!

Australia is famous for its deadly venomous snakes. Companion animals are often bitten when they are interacting with (chasing, playing with, attacking) snakes. There are plenty of reports of dogs and cats being bitten by brown and black snakes (elapid species), but until recently nothing published in the peer-reviewed literature on bites from Black whipsnakes (Demansia papuensis species group). As my co-author, herpetologist Glenn Shea, says, “Black whipsnakes are venomous, and similar in size to the ‘traditional’ dangerously venomous species, such as black snakes and brown snakes.

During a locum stint in Darwin I treated a 9-year-old Jack Russell terrier, Molly, who sustained a bite from a Greater black whipsnake. There were a number of interesting things about this case.

Poor little Molly 72 hhours after envenomation. Note extensive bruising and swelling. (Also a yellow bandage this time because we can out of pink and blue). Fortunately she made a full recovery.

First is that the bite wound caused severe, painful local necrosis, swelling and tissue damage that progressed from the time of initial presentation. Whilst there is no direct evidence that the venom is fatal, the site of the bite and subsequent swelling may cause life-threatening complications (for example a bite to the neck or chest which causes swelling that may affect the airways).

Second, Molly required treatment (pain relief, anti-inflammatories and supportive care) even though it is anecdotally reported that these snakes aren’t harmful (humans that have been bitten say that it really, really hurts).

Third, the dog tested negative on a snake venom detection kit which suggests (although N=1) that these kits cannot be used to rule out whipsnake envenomation.

A Black Whipsnake in the NT (note this snake was deceased when found).

Of course not all snakes are to be feared - just treated with caution and good care. All snakes are deserving of respect. Including this little cutie-pie here.

Reference

Fawcett A, Shea G and Cutter SM (2014) Black Whipsnake (Demansia papuensis species group) envenomation in a Jack Russell terrier. Australian Veterinary Practitioner 44(2):627-630.

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.

Festive season hazard: chocolate & FREE toxicology webinar from VetGirl

This is Belle, who comes from the Australian Capital Territory. We're loving the ears, but suspecting that
Belle is looking to the photographer with the expectation of some kind of food payment.

Here at SAT we are totally excited about the festive season and all that it brings - time with family (all species included), more time outdoors, a sense (however deluded!) that the workload is winding down and the sense of a new beginning. But the festive season is a time when even the non-traditional buy into tradition, resulting in the proliferation of pet-inappropriate foodstuffs in every household.

Today's focus is chocolate. We can't get enough of the stuff, but its toxic to animals and dogs are the number one victim because they are the least fussy in their eating habits. I can tell you, from inducing vomiting a gazillion times, that dogs don't care if they eat the wrappers. 

Chocolate contains methyxanthines (eg caffiene, theobromine) which can cause cardiac and central nervous stimulation, as well as have a diuretic effect. It also contains a lot of fat which (contrary to the beliefs of those who feed their dogs all the gristle from their BBQ) dogs generally don't tolerate as well as us. 

The more cocoa the chocolate contains, the more toxic. So the least toxic is white chocolate, while the most toxic is the increasingly trendy hard-core high-percentage of cocoa gourmet chocolate that everyone seems to like to give everyone at Christmas.

Toxicity will to some extent depend on the size of the dog. A single square of very dark chocolate or cooking chocolate can make a tiny dog very sick...but may not harm a big lab. (Mind you, I would also like to add that big labs DO NOT STOP AT ONE PIECE. I've met labradors who ate entire family blocks in one sitting - in one case 2kg of chocolate - and would eat more if they could find it)(and no, inducing vomiting in such a patient is not pretty).

The serious part, folks: chocolate can kill. As little as 30g of cooking chocolate can kill a 5kg dog. And remember it can be hidden in cakes, brownies, chocolate chips, cocoa powder and cocoa mulch. Oh, and chocolate coated coffee beans. Double-whammy.

So if you think your dog has found your sweet stash, call your veterinarian. It is worth inducing vomiting early in the piece (ideally within 1-2 hours) because this can minimise absorption and signs of toxicity.

Clinical signs of chocolate toxicity usually refer to excitement, and they include restlessness and hyperactivity, panting, signs of nausea like salivation, vomiting (usually brown coloured and possibly containing colourful wrappers) and chocolately-diarrhoea.

Severely affected dogs may exhibit polydipsia, polyuria, ataxia, muscle rigidity, tremors or seizures. Some dogs become cyanotic and require immediate oxygen therapy. Coma can also occur. In addition, if your dog suffers from pancreatitis, a chocolate pig-out will often precipitate a raging bout.

The good news is that most owners are pretty cluey about chocolate being bad and we tend to induce vomiting and send them home. In severe cases dogs require anti-seizure medication, IV fluids and 24 hour monitoring.

If you live with a food motivated hound, you might want to keep your chocolate in a safe.

Also if you're into toxicology, you will want to sign up for VetGirl's seminar on the top 20 poisons affecting your small animal patients. Sign up here.

Common herbicides may be harmful to lizards and reptiles & zoo seminar

This baby bluetongue is good for your garden. Be careful with any herbicides you use as they may have an adverse effect against lizards and other reptiles.

UPDATE: The NSW Department of Primary Industries has published a review of pesticides used in the management of vertebrate bests, including environmental and non-target risks. Read it here.

Glyphospate-based herbicides are extremely common, the most popular of which in this part of the world is a product called Roundup (so popular in fact that plebs like me who don't garden still know what it is).

Like many "icides", herbicides can have negative effects on non-target organisms (the target organisms in this case being weeds). Herbicides contain not only active ingredients but also adjuvants - products that improve the stability of the compound and enhance efficacy.

While all such products are required to undergo toxicology testing prior to registration, these studies have traditionally looked at the impact of the toxin on birds and mammals. Reptiles have been overlooked, which gives you a bit of an insight into the social status of reptiles. 

This stunning pair, named X and Y (look at their dorsal markings...) should melt the hearts of even the least reptile-oriented.

Dr Stephen Cutter, of the Ark Animal Hospital, and reptile veterinarian, alerted me to a fact sheet put together by the New Zealand Department of Conservation on "The effect of glyphosate herbicides on lizards".

A study using two glyphosate products (Yates Roundup Weedkiller Concentrate and Agpro Glyphosate 360) on the New Zealand common skink (Oligosoma polychroma) found that they changed skinks' thermoregulatory behaviour and decreased sprint speeds, both possibly predisposing to a greater risk of predation. The effect wasn't consistent between the two products, so that is also interesting as it might be adjuvants or something about the formulations that is responsible and not the glyphosate per se.

One has to be careful in interpreting such findings. First of all, the two selected products aren't singled out because they are worse than others - they happened to be the two products studied. Other products may actually be worse so don't simply avoid these two products and assume that all other products are fine.

Secondly, we're talking about a short-term study involving one species in a particular climate. This herbicide might be more or less toxic to other species or indeed individuals.

When it comes to animal welfare I think that there is a need for more evidence, but my approach is to err on the side of caution - i.e., be really selective about where you use the product and use it really cautiously in gardens inhabited by reptiles.

A water dragon suns itself on the fence.

Incidentally, if you do want to provide a nice environment for the reptiles in your yard, you can do a few things:

• Reduce predators. If you own dogs, cats, ferrets etc, establish barriers through which reptiles can escape but others cannot fit (harder with ferrets, I know)(one of SAT's most popular posts is a case study of Jane, a pink-tongued skink who had an altercation with a dog and required an emergency caesarian as a result).
• Reptiles love native plants and leaf litter, so aim for a native bush garden;
• provide a good rock or some planks for sunbaking (in an area where potential predators can't access them);
• make sure there is shade as well as access to sun as this provides a natural heat gradient.

Dr Cutter also informed me that the animal-obsessed can improve their choc-chip cookies by turning the choc-chips into tiny spiders.

I also recieved an email about a fantastic seminar tonight by Professor Barbara Creed entitled Apes & Elephants: modernity, zoos and the search for sensationalism. It is being held at the University of New South Wales, Webster Theatre A in the Robert Webster Building on the Kensington Campus from 5-6.30pm.

Professor Creed will discuss the European fascination with tropical animals in zoos throughout the 19th century. 

According to the blurb,

Zoos became places where human animals could experience the chill of a backbone shiver as they came face to face with the animal/other. It will examine the establishment of the first zoos in relation to Harriet Ritvo’s argument that their major imperative was one of classification and control.  On the one hand, the zoo fulfilled the public’s desire for wild, exotic creatures while, on the other hand, the zoo reassured the public that its major purpose was control of the natural world encapsulated by the stereotype of tropical excess. I will argue that these various places of exhibition created an uncanny zone in which the European subject was able to encounter its animal self while reaffirming an anthropocentric world view.

I am interested in zoos and zoorism so very disappointed I won't be able to make it, but would love to hear from anyone who pops along.

Artificial sweetener xylitol is toxic to dogs: the case of the killer muffins

Xylitol is an artificial sweetener which is fine for people to eat - but a threat to the health of pets.

Dog owners should be aware that the artificial sweetener xylitol is highly toxic and potentially fatal to dogs. Cases of canine xylitol toxicity have occurred when dogs get into sugar-free gum with xylitol in it, but also when dogs eat baked goods containing xylitol.

We treated a young staffy cross who presented almost two days almost two days after consuming muffins baked with xylitol. (They were cooling on the kitchen bench, and the patient couldn't stop at one. She ate at least a dozen - which demonstrates another principle of canine toxicology: if it tastes good and no one is watching, the dose inevitably climbs higher).

What saved this dog was that the owner knew the ingredients of the muffins - having baked them herself, so I had an early suspicion of xylitol toxicity. The dog had eaten a LOT of xylitol (by my calculations, around 10.5g/kg). 

She had signs of vomiting, inappetence, lethargy and weakness, followed by jaundice.  Not only was she hypoglycaemic, a finding we knew was associated with xylitol toxicity, but she went into acute hepatic failure – something which has only more recently been associated with xylitol toxicity in dogs. 

She turned yellow as a banana, developed a coagulopathy (clotting disorder) and we really did not think she would make it. We treated her with IV fluids, glucose (initially), hepatoprotectants (SAMe and Mucomyst), gastroprotectants, antiemetics, antibiotics and vitamin K1 – combined with some late nights, early mornings and crossing our fingers and toes!

She made a complete recovery but it took  around 11 days. That allowed plenty of time to read everything there was about xylitol in the literature.

We learned that xylitol, a sweetener which is safe in humans, is incredibly toxic to dogs and can lead to acute hepatic failure. So even dogs which are not hypoglycaemic on presentation may require treatment for hepatotoxicity.

When we contacted the manufacturer she told us of at least one vet who sent two dogs home thinking they would be fine after eating cookies baked with xylitol. Both dogs subsequently died. This particular manufacturer was keen for more veterinarians to be aware of the potential for canine fatalities from this product.

-    Dogs with a history of eating 0.15g/kg or more of xylitol should be treated aggressively, and those with a history of eating 0.5g/kg or more may benefit from pre-emptive treatment with hepatoprotectants, particularly N-acetylcysteine (Mucomyst) and SAMe as this may prevent mortality.

For anyone interested in reading more, we wrote up the case in the Australian Veterinary Practitioner. We subsequently learned that the UK's Veterinary Poisons Information Service (VPIS) has campaigned for manufacturers of xylitol to provide visible warnings and information on packaging about the effects of xylitol in dogs and to educate manufacturers about potential risks. 

But when I asked if they stocked xylitol, the saleswoman at my local healthfood store told me that xylitol would be great for dogs – because it is great for humans.  The disparate effects of xylitol on one species vs another proves again that dogs are not little people.

Reference

Fawcett A, Phillips A and Malik R (2010) Hypoglycaemia and acute hepatic failure associated with accidental xylitol ingestion in a dog. Australian Veterinary Practitioner 40:142

Three things I learned: snake envenomation in dogs and cats

This little snake doesn't intend any harm - and many don't, but snake envenomation
 is common in Australian dogs and cats.

The ASAVA hosted a webinar on snake bite envenomation, fortunately a condition very rarely seen in inner-Sydney. Dr Peter Best, a specialist based at South Tamworth Animal Hospital, clearly knows everything there is to know about snake bite envenomation right down to the molecular level.

Every year there are an estimated 6,000 snake bite envenomations of dogs and cats in Australia, with jack Russell terriers and Siamese cats overrepresented. (Am I alone in being surprised about Siamese cats?) – although Dr Best did point out that survival rates in cats were likely higher because cats are more agile and therefore may not get the full dose of venom. Of the humans affected, herpetologists and young, inebriated blokes are overrepresented (still more surprised about the Siamese cats).

More good news is that up to 50 per cent of bites did not result in envenomation – either because no venom was delivered or it didn’t penetrate skin.  But it’s impossible to be sure – even if you run diagnostics.

I could easily list 30 things I learned in this presentation, but the three main points I learned were:

a)      Onset of signs can range from minutes to 25 hours. That means that animals with suspected envenomation should be admitted for observation for 25 hours – and if they do deteriorate they can deteriorate rapidly.

b)      Dogs with pre-paralytic signs (i.e. vomiting, salivation, mydriasis and transient collapse) can recover – but the fact that they exhibit these signs mean they have had a potentially lethal dose. They need to be treated with anti-venom immediately. As with all things cats are a bit less obvious, being a bit weak and wobbly

c)       In human medicine the current trend is to give a fixed amount of anti-venom, but according to Best and his team this strategy does not work in dogs and cats. He recommends providing intermittent, positive pressure ventilation (IPPV) and administering anti-venom vials repeatedly (at intervals of around 10-30 minutes) until spontaneous ventilation occurs. (He pre-meds his patients with an IV antihistamine and a SQ dose of adrenalin).  One dog his team treated for brown snake envenomation required a staggering 13 vials of anti-venom (oh, and also two packs of whole blood, one of fresh frozen plasma and artificial ventilation for 36 hours). He survived.

It was an inspiring presentation,  based on a huge amount of clinical experience integrated with solid theory.