Archive | December 2011

Tis the Season for. . . .Chocolate!!!


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          Christmas is a wonderful, fun time of the year…. until your dog eats an entire stocking full of Hershey kisses, Tootsie Rolls, M&M’s, Peanut Butter cups and then finishes up with your box of Russell Stovers’s  mixed chocolate assortment and a few Lindor Truffles just for good measure. Now, you are at the emergency veterinary hospital, Christmas just got a little more expensive and you are definitely not enjoying the holidays anymore!  At this point, you are just hoping that your dog survives this Christmas and lives to see another.

          Chocolate contains theobromine and caffeine, both of which are toxic to dogs and cats.  There are varying amounts of these toxic ingredients in different types of chocolate.  Baking chocolate and dark chocolate have a much higher concentration than milk chocolate and white chocolate.

          If you are lucky, your dog will feel nauseated from eating all this chocolate and throw up. The messy chocolatey vomit will definitely not be pleasant to clean up, but at least most of the chocolate will be out of your dogs system.  If you weren’t this lucky then definitely call your veterinarian first. Many times our sneaky little pets gobble up all these goodies when we aren’t home and its hard to tell how much time has elapsed since it was initially ingested.  Usually, our first bit of advice is to induce vomiting with hydrogen peroxide. Then, depending on size of the dog, amount that we think was eaten, clinical signs, and time elapsed we may have to see your pet for hospitalization and observation.

          Clinical signs that may be observed with chocolate toxicity include nausea, vomiting, panting, weakness, ataxia (a neurological condition where they appear to be drunk when they walk), diarrhea, hyper-excitement, muscle tremors, and seizures. It can also cause hyperthermia, an increased, rapid heart rate, and cardiac arrhythmias. Chocolate can even cause death due to prolonged cardiac arrhythmias and respiratory failure several days later.

          Treatment is aimed at 1.) decreasing further absorption by inducing vomiting and possibly administering a compound called activated charcoal to help adsorb some of the toxins. 2.) increasing the excretion of the toxins. This is done by administering fluids to increase blood flow through the body and kidneys. 3.) providing symptomatic relief. We can give drugs to calm muscle tremors and rigidity and stop seizures. There are medications to calm nausea and vomiting. We also have medications to slow the heart or correct cardiac arrhythmias.

          Fortunately most cases of chocolate toxicity end happily and do not require extensive hospitalization. However, it has the potential to be very serious and even deadly so be aware of this tasty toxin and take the precautions necessary to keep your pets safe during the holidays!

Merry Christmas from everyone here at Heritage Veterinary Hospital!

Dr. Stephanie Bradley


Buster Man, quite the swimmer…

Hello all!

The inevitable finally happened over the weekend. Buster was outside, I was standing at the back door watching him. He started walking very near the pool. I called his name…he looked in my direction…his foot slipped…into the pool he went! I’ve always wondered what my plan would be in this particular situation. I’ve gone through the scenario multiple times in my head. Some involved grabbing the pool skimmer and scooping him up and out of the pool. Some involved a glorious swan dive and powerful butterfly stroke that eventually resulted in his dramatic rescue.

It wasn’t so graceful as all that.

My husband compared my immediate rush into the pool to a crazed “spider monkey”. Let me tell you, a foray into the Polar Bear Club was not on my Christmas list this year. That was some VERY. COLD. WATER!! Luckily, Buster was saved quickly and hopefully has learned not to follow the sound of flowing water in the backyard…

At this point, its probably pretty obvious that he has not regained much vision but I’m happy to report, his glaucoma is successfully managed. It was going so well in fact, his opthalmalogist and I attempted to try to wean him down on his glaucoma meds. “Attempted” is the key word. Unfortunately, he was not quite ready and his pressure started to creep up again so it was quickly determined that we had to go back to his old med schedule. (I was REALLY hoping to decrease the frequency of meds as he is currently on 7 different ones and they must be given at least 5 minutes apart 3 times a day). Oh well, thank goodness for small favors right?

Thanks so much to everyone that has been following Buster’s harrowing adventures. Your kind words and prayers have been very much appreciated this holiday season. I hope everyone has a very Merry Christmas and a Happy New Year!

Jessica Zink, DVM

Buster Man snoozing in the break room


A client sent me a great link showing how resourceful and smart our canine friends are.  This dog has a disease called mega esophagus and so has extreme difficulty swallowing correctly especially with her head pointed down (the normal way to eat and drink).  So the owners built a special “table” so she would not choke at meal times.

Megaesophagus is a dilation of the muscular tube that connects the throat to the stomach.  Generally it is because the muscle is weak and movement of food (peristalsis) is absent.  It can be congenital (beginning at birth).  It is genetic in wirehaired fox terriers, miniature Schnauzers, also Dachshunds, German shepherds, Great Dane, Irish setters, Labradors, Pugs, and Shar-peis.

Other causes are Myasthenia gravis (neuromuscular transmitter disorder), lupus, dysautonomia, tetanus, botulism, Vagal nerve trauma, vascular ring anomaly, cancer, obstruction, granuloma, lead, thallium, Addisons (low adrenal hormones), hypothyroidism, thyomas, and esophagitis.

The signs we see are vomiting/regurgitation, coughing after eating or drinking, nasal discharge, and also weight loss.  Because the food and water are often aspirated (inhaled into the lungs), pneumonia is commonly seen and can be severe and fatal.  The diagnosis is often made with an X-ray and also sometimes a barium swallow to watch the progression of water/food down the esophagus.

The treatment is always directed at the underlying cause.  Some diseases such as vascular ring anomaly and strictures can be treated surgically.  Unfortunately puppies with congenital disease have no permanent cure so infections and pneumonia are treated with antibiotics.  Other drugs used are prokinetics to move food quicker (reglan and cisapride), h2 blockers (Tagamet and Pepcid) to decrease stomach acid, immunosuppressive drugs for autoimmune diseases, and special drugs such as pyridostigmine for myasthenia gravis.

This disease generally requires life long therapy, owner dedication, and many follow up exams and visits by your veterinarian.  The ultimate outcome is often not rewarding as the majority succumb to aspiration pneumonia.  But often times, as with the Bella the dog in the above video, there are many things and medications that can help and make their quality of life much better.

Luckily this disease is rare and not often seen.

Dr. Joe

Update on Buster

Buster today

Hello all! It has been a bit of a rollercoaster over the course the week. Buster’s pressure has flucuated a great deal and despite 3 emergency efforts to reduce it which were only briefly successful, I think we have finally achieved a good, steady pressure level. Unfortunately, this may be more optimism than is really appropriate as the pressure has only been reliably down for around 24 hours. Nevertheless, I’m going to maintain this positive outlook because he has been unable to maintain a decent pressure for even this amount of time.

The details of this week are pretty scary and pretty remarkable at the same time. The emergency procedures I am referring to involve giving a medication called Mannitol which is typically used in head trauma cases to remove excess pressure on the brain. This medication is a concentrated salt solution and causes fluid to shift away from normal tissues quickly and by itself comes with its own amount of risk. For this reason it is typically reserved for the most critical of cases and unfortunately Buster fit that criteria. He had Mannitol on Tuesday m0rning and his pressure was reduced a great deal pretty quickly but went back up by the next day so had to be repeated. Unfortunately, the second time the pressure was only reduced for a few hours and went right back up into the mid 60 range. As a reminder, normal intraocular pressure should be under 20 and humans have described pressures in the 40-60 range as the most excrutiating migraine pain they have ever experienced. At that point, I became extremely worried and so with the help of his opthalmalogist, Buster was anesthetized and fluid was physically removed from the front chamber of his eye using a small syringe. This is not a commonly performed procedure but with a pressure as high as Buster’s was and without the ability to administer more Mannitol safely, it was our only remaining option to hopefully preserve vision in that eye. After having gone through all that, poor Buster again had very high pressures the following day. At that point, the opthalmalogist and I discussed the last and final option to preserve the eye. Cryotherapy was his recommendation.

Cryotherapy is a procedure that freezes portions of the structures that produce fluid (the ciliary bodies) in the front portion of the eye. This procedure has many potential complications. It nearly always causes a great deal of inflammation within the eye (uveitis) which by itself can cause many problems that may have future consequences on the ability to retain vision. Another set of potential issues is if too much of the ciliary body is damaged,  the eye is unable to keep filled and retain its shape and if too little is damaged, there is still too much fluid being produced and the glaucoma is not resolved. The good news is that approximately 70-75% of animals will have function following this surgery despite the potential for complications. I was still very nervous as it would involve yet another round of anesthesia for Buster and given his previous poor luck, I was concerned that Buster may again be in that 25-30% range. I made plans to leave the office early to make a trip out to the surgeon’s office and then, miraculously, something happened. Buster’s pressure started dropping. Neither myself nor Buster’s ophthalmologist are quite sure as to what may have changed to drop his pressure after previous efforts had failed but after arriving at his office, Buster’s pressure was still just under 10 so we decided to postpone the surgery. I am happy to report that his pressure this morning was 11 and seems to be holding. I am still unsure as to whether he will retain his ability to see as his pupil has been very constricted this entire time which prevents vision and I have also been unable to assess the health of his retina, but at least the excruciating pain has passed and that is something to celebrate. I will keep updating as things progress but for now, I will just enjoy his happier attitude and hope for the best.

Jessica Zink, DVM

The Joys and Struggles of Cataract Surgery: From an Owner and Veterinarian’s Perspective

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My old man, Buster, is one week out after having cataract surgery. Let me give you a little background on him. Buster is a 14 year old Rat Terrier that started developing cataracts about 5 years ago. Cataract is a collective term that, at its most basic definition, describes a loss of transparency of the lens that is usually hereditary and eventually leads to blindness. Not all opacities in the eye are the result of a cataract. A common cause of cloudiness seen in the eyes of an older pet is nuclear sclerosis. Nuclear sclerosis is the result of normal aging changes that cause stiffening of the lens  and do not affect vision. Your veterinarian can make the distinction between the two.

Ok, back to Buster. For starters, this little guy has been the apple of my eye since he was 6 weeks old. He has had issues with anesthesia in the past which prevented me from having the procedure done earlier. It was only his recent major loss of vision and the fact that I have a pool in my backyard that made me finally come to the decision for him to have the surgery. The surgery to which I am referring is termed a Phacoemulsification. In this procedure, a veterinary opthalmologist makes an incision into the eye at the junction of the sclera (white part) and cornea (clear part). An instrument is then inserted into the lens capsule (the tissue surrounding the lens) and using high-frequency ultrasonic waves, the lens is shattered and removed. Many surgeons will place an intraocular lens implant in the remaining lens capsule to aid in vision correction. Buster had an implant placed during his surgery and upon recovery was able to see quite well that day.

According to current literature, approximately 95% of patients will have useful vision and relatively low complication rates. Unfortunately, Buster is in that 5% category. The most common complications associated with a surgery of this nature are uveitis (inflammation within the eye) and glaucoma. Buster is currently struggling with what was previously moderate glaucoma the day after surgery and has recently become full blown severe glaucoma. Glaucoma is increased intraocular pressure or increased pressure within the eye. Signs of glaucoma are cloudiness of the cornea,  red sclera, and a bulging eye. Unfortunately, this by itself will cause blindness.

Let me start by saying that cataract surgery is the best way to improve vision in a pet that has developed cataracts and subsequently, vision deficits. It is a surgery that I have observed multiple times and I know it to be very safe and tremendously helpful to those pets whose quality of life is suffering due to issues with vision. I have recommended the surgery on numerous occasions to clients and have seen great successes. Unfortunately, my own experience has been more challenging and thankfully I am a veterinarian and am able to monitor Buster for rapid changes that jeopardize his recovery. It is still very touch and go, his pressure today is 63 where normal intraocular pressure is under 20. This has been a rapid development and he is under therapy but it is very painful both for him and for me. He is disoriented because he can’t see and glaucoma can be very painful all by itself. I am hopeful that the treaments received today will greatly decrease that pressure to a more normal level but the question remains, how long will it last?

 Cataract surgery is not for every pet. Many pets will do very well with decreasing vision, even to the level of blindness as it is typically a slow progression, unless induced by diabetes which can cause rapid development of cataracts. The point to focus on is that many pets will adjust to declining vision and cope nicely. I will always advocate for the surgery if it is within your means to provide it, even with the difficulties I have experienced with my own dog. I will keep you posted as to Buster’s condition and hope that everyone has a happy, healthy holiday season.

Buster man post-op, evening after surgery

Jessica Zink, DVM

Cushing’s Disease: What You Need to Know

I had a question on TV the other day and I thought I would “reanswer” it here and expand just a little. The viewer asked about Cushing’s disease and medications. The technical term is hyperadrenocorticism and although there are different causes, all result in excessive production of steroid.
The signs may include excessive thirst, excessive urination, increased appetite, sagging abdomen, panting, hair loss (or failure to regrow), darkening of skin, muscle weakness, weight gain, and lethargy. There are other signs that your Veterinarian could recognize and point out as well. Like other endocrinological diseases, Cushing’s can be managed with medication depending on the cause. If the cause is from the pituitary gland (master gland of the body in the brain) then usually Mitotane (Lysodren) or Trilostane (Vetoryl) are good choices.  If the cause is from a tumor of the adrenal gland itself (located near the kidneys in the abdomen) then either Mitotane or surgery is indicated. Generally speaking most causes are from the pituitary gland and have a very good chance of a favorable response with medication. On the other hand, if the cause is a tumor in the adrenal gland then the prognosis is much worse (cancer).  There are several blood tests your veterinarian can use to diagnose this disease.If anyone notices several of the above signs,  make an appointment for your dog to have a physical exam by your Veterinarian. The signs are actually not always specific to Cushing’s disease and your Veterinarian will discuss other possibilities and tests to consider. 
Dr. Joe        

Weight Loss and What it May Mean for Your Pet

Hey all! AA Patrick reminded me why it is so important to keep track of your pet’s weight. So I wanted to take a minute and discuss weight loss in pets.

Weight loss is considered significant when it exceeds a 10% loss in a short time or 15% over a longer time without a decrease in food normally offered. Weight loss may be associated with a normal, increased, or decreased appetite. Your pet’s food intake amount is helpful in determining a possible cause if he or she is getting thin. Other important signs to note are muscle wasting, energy level, water consumption, nausea, vomiting, diarrhea, coughing, and mentation. Sometimes the cause is as simple as a miscalculation of the amount of food but more often it points to disease. There are many possibilities such as intestinal disorders (i.e. inflammatory bowel disease, parasites), endocrine (i.e. diabetes, hyperthyroidism), metabolic (i.e. heart, kidney, or liver failure), and nervous system (i.e. stroke, nerve degeneration of jaw muscles). As well as many many others which is why if weight loss is suspected, a physical exam by your Veterinarian is the best starting place. The first step is on his or her scale!

Thank you to every one who supports Animal Aid and helps dogs like Patrick.

Dr. Joe