I AM NOT AN E.R. The Story Of Sophie. Baclofen Toxicity

It has been a week since I last flossed. It seems like a confessional to the internal self to seek a pardon, and once again, promise to do better. It seems I seek a peaceful acceptance of all of my inadequacies within my inabilities too often.

This week was exactly like this… a series of internal confessions with a humble begging for forgiveness to a self that doesn’t take disappointment, or failure, easily.

This day, this Wednesday evening, within this moment, was about Mollie, Genie, Maxi, Taylor, and Sophie. They were all in some degree of desperate dying. Each patient was supported by at least two technicians, all wondering the same thing as I; how could so many catastrophes happen at once?, and, which one would start to crash/die on us first?

“We are not an E.R.” I hear myself produce these words almost daily these days. I am not sure why I even try to explain, or, perhaps more realistically, excuse myself. For every 100 times I recommend to a client that they transfer to the ER, 1 actually consents and goes. People just don’t/can’t/won't/refuse to go. For some of these cases they have already tried to get in. They have called, been directed to sign in via the online portal, and been notified that there is a 10 to 24 hour waiting period. People who are desperately worried for their pet’s life are not going to wait 10 hours. So, they drive to us. Many just show up. Arrive unannounced. Crash a party and hope that the door is open and the staff is welcoming. Depending on the degree of the emergency they may have called us. May have spoken to our Charge Tech to plea their case, which gets parlayed to a vet, and almost always given permission to “come up, be patient, and we will do our best.” I try with each case to set the stage for the reality that we are “not an ER” and may have to transfer them to one should it be in the best interest of the patient to do so. I know that even with this preface, this CYA blanket statement, that I invite the chaos, and hence, I internally beg for forgiveness yet again when I get myself too deep in the shit pile.

At 7 pm I was standing, circling and losing my mind amid the evenings vetmed emergency offerings I had unintentionally invited to my own misery party. I looked into the surgery room. On the table to the left was an 8-month-old puppy. I’ll call her Sophie. She was intubated, on oxygen, and poorly to absently responsive. Under her head sat a bucket of vomit with specks of white pills. To the right of her was Taylor. A five-month-old tabby with fluid in his chest. He was sleeping in a clear plastic box full of life saving, life giving super saturated 100% oxygen. He was happy and loving his time with us, thanks to the oxygen. Just outside the doors to the surgery in a little stainless-steel cage sat Mollie. She was barely visible behind her cluttered cage door with its two fluid pumps, iv fluid bags, (also two), and a clipboard holding checklist of her too numerous medications. You couldn't see her adorable face with its white fluff mane that surrounded her blunted nose and omni present wide mouthed grin framed within the haloed plastic e-collar. She was sitting up on her front feet but straining and posturing her back legs. She had spent the last week like this. Trying in vain to push out a stone that was lodged so deep down her urethra it was only permitting a drop of urine at a time to pass. In the cage beneath Mollie was Genie. A sweet, slow, aged Dobie who had been vomiting for four days. She came in as a mystery ailment and she remained the same until the next day when the 4-year-old in her family confessed to feeding her a whole box of chewy milk-bones. She was in critical condition and not able to move, except for the vomiting that just spilled out of her mouth as she lacked the strength to pick up her head. Skip a few feet to the left and there was Tigger. I.v. catheter running saline into his veins in the hopes we could flush out the grit in his bladder and dodge the need to place a urinary catheter. He had arrived 3 days earlier just about to block. We mounted the most aggressive defensive plan we could to spare him a urinary catheter and his mom the price tag it came with.

Gastric lavage

Within these moments time stands still. I have to suspend it. It is the only way I can muster all of the senses to attention to compute the vulnerabilities and re-assign staff to guard the weak points. I know, I know deep in the seat of my gut, that at least 2, maybe even four of these guys are going to die in front of me. Probably in the next few minutes to hours. “I am not an E.R.” I remind only myself this time.

This is one of the best examples I can give of where vetmed is now. We have burnt so many people they don’t trust, or don’t want to be sent to an ER. For all of the many reasons the ER’s have gotten themselves in the predicament our clients see them as, it doesn’t change the reality that accidents, illnesses and yes, even death comes to find us.

I see my husband for about 15 minutes daily. 15 minutes when I get home, typically around 9 pm, starving and exhausted. He has a meal waiting, typically two hours old, as I never get my ETA correct. I do not recollect any of the meals from the last week. Only that I inhaled them, and that the portions were too large. We go to bed with me feeling like a bloated corpse, and him angry that I cannot ever say “no.” He reminds me of my limitations and the power of “NO.” I remind him that there are few options in these scenarios that I can live with. I remind him that I am reminded that if I don’t help, I don’t know if anyone else will. If martyrdom was a pageant, I could have a crown to sit upon. Think I am being foolish? Well, lets talk about each of these cases in a little more detail. Wonder why I don’t floss? Well, I don’t do anything in this state. I fall asleep as soon as I hit my bed. Surrendering to the exhaustion like the coma that claims me. I repeat this Monday-Tuesday-Wednesday and Thursday. I fall off to sleep worried for the patients I saw. Fearful for those I failed, and afraid for those I will see. I cannot say “No” to these either. They find me in my dreams.  Even here, as I try to rest I see them. I worry and react for them. I send them treatments, and apologies. A figment of a life preserver even here, when they aren’t near me. 

The routine day

On the night before a dog arrived with much the same scenario; "ER has a 10 hour wait. Patient is bleeding everywhere from a dog fight." We explain to the caller that we will do our best to help, but, if sedation or anesthesia is needed they will have to head to the ER. When they arrived it was after 6 pm. I was told that he was "bleeding everywhere" so I rushed in to see him. There was blood splatter on every wall in the exam room. He had been there for less than 5 minutes. The wounds to his left ear were so significant that I was not able to fully assess whether ear needed reconstructive surgery. The ear was not being held up at a normal (or symmetrical) angle on head. There were about a dozen (maybe more) wounds to the top of his head that included both puncture wounds and lacerations. Some appeared to have pocketing and underlying muscle damage. Again too bloody and painful to assess. Wounds appeared to go over to right ear, base of ear and included the neck. As with all wounds of this severity he was too painful to assess fully without pain meds and sedation, and most probably required general anesthesia. I advised them to go to ER. When I mentioned the ER the owner became volatile. She shouted and became angered. She would not to go to ER! she yelled, so I offered analgesics and antibiotics as initial treatment option but again warned that wounds may need clean up to check for degree of soft damage, and tissue damage. I told the owner I was also concerned about pain, bleeding, and high infection rates with dog bite wounds. Owner declined again to go to the ER, and take any medications. The owner went on to say that "this dog had cancer and she would not wait 10 hours at ER to be told he doesn't need anything." I attempted to diffuse her and offered pain management and antibiotics again. She stated that I was being rude. The owner got up, took her dog by the neck and began to leave exam room. She kept yelling, repeating that I was rude, and she was not going to ER. As she was leaving I told her to not return to us, nor treat staff this way. When I said this she turned around and charged at me with a hand in my face and the words "I'm going to beat your face." 

That's what advising someone to go to the ER can get you. She was served with banning papers from the Sherriff the next day. Yet another gem to add to my Wednesday fiasco.

My Storm,, his happy place.

Sophie is 8 months old. She is a wire-haired terrier just fostered and adopted by an older couple who adore her. For all of the mischievousness of a terrier, (vets tongue-in-cheek refer to them as “terrorists”). They find her antics, her strong opinions, and fierce compulsions, adorable. (I can relate, my parents felt the same about theirs. I grew up with 5 generations of Jack Russell Terrorists. They killed our cats. They killed any small thing that scurried). Sophie has a boxy face, tan highlights to a brown face and inquisitive soft intelligent eyes. Her ears stand with a little bow at the tips and she is formidable in a compact package of taught muscles and youthful velvet softness. Sophie was carried into the clinic in her mom’s arms as she burst in the front doors like a hurricane. I was alerted to their arrival by my receptionist who quickly came rushing into the treatment area yelling, “EMERGENCY! WE HAVE AN EMERGENCY!” arms flailing above as if waving down a passing car. I walked to the front and her sobbing mom attempted to pass over her lifeless puppy to me and asked myself, “why does this place feel like a firehouse on some days?” 

It is exactly in this moment that I have to decide. I do not extend my arms. I do not rush to offer some act of heroism in a crucible of mercy. I have to make that split second decision as to who I am and who I want to be remembered as. It is in this second that your marrow matters. It is here that your consequences, your good deeds, your ethos, and every second of every tid-bit of training finds you. Your actions here will haunt you. I know this. This is the place where some vets will offer “humane euthanasia” while others will offer extremis estimates for a chance, and many will take a bad situation and make it hopeless. (To be honest I never quite know if I ever pick the right offering of an answer. More on this with Genie’s story to follow). What I wanted to do was ask her to remain there. Put her on a pause, holding her rag-like puppy and make a quick physical exam assessment and,,, punt. HARD. I did not want to be responsible for her. I did not want to be responsible for a hysterical mom feeling guilty about an accident I have seen so many times before. I did not want this dying puppy. I didn’t want any of the hers in front of me asking for help. Now I know this sounds cold and cruel, but the reality was that I had just finished a long morning of over booked surgeries. I had come in early, after getting home very late, to try to cram in all of the things that I had scheduled. There was not enough room for them, never mind the falling deaths from the skies. I know this. I know I am supposed to say "NO!" I looked at her puppy, I looked at her, the words slipped out softly, “I am not an ER.” I knew we didn’t have the manpower, the time, nor the facility to help a puppy in this state to the degree she needed. Sophie was purple, barely responsive and I was pretty sure she was dying in her moms arms, if not already dead, and would die on her way to the ER. I clumsily said as much. Mom begged me to “try” and I am a sucker for that word. It is my verbal kryptonite. No other word compels me. Mom was hysterical. Mom was not safe to drive. Mom was not going to make it to the ER with Sophie alive.

 

Sophie was in such a terrible state that I knew she had a very narrow window. I took her in my arms and we headed into the treatment area. Over the next few minutes the story of Sophie’s predicament unfolded. Her parents had left her at home for a few hours. When they came back she ran to greet them, same as always. Within a few minutes she had vomited and then they found the chewed up pill bottle. Scattered around the bottle were large white aspirin-powdered pills. Baclofen. The label was so chewed up that we had to use the pills and pharmacy information to identify them. The bottle was filled for a 30 count. 13 remained. As the technician called Pet Poison I debated her degree of consciousness and whether she was awake enough to induce vomiting. She was not. Sophie had dried bloody, thick, taffy-like saliva and vomit in her mouth. I tried to clear it. It was a sticky-spiderweb goo that left your hands incapable. Sophie was placed on the x-ray table. She had a huge distended stomach full of,,,, well, seemingly dog food and pills. We whisked her to the surgery table, quickly intubated her and provided oxygen to her purple lips and tongue. She was slipping into a coma. Four people, two of them veterinarians, swarmed around her tiny new body. We placed a stomach tube. We lavaged the stomach contents in a desperate effort to remove as much pill-peppered-ingesta from her stomach as we could. The clear plastic tube sucked out tan kibble speckled with white powdery-pieces of pills. She gagged once, whimpered once, and lay lifeless for the rest of it. I gave her intermittent breaths of oxygen and told her that I was sorry. I told her she was loved and I watched the staff so desperate to help and so foreign in this act of emergency procedures. Sophie gathered a crowd and I barked orders to try to turn a tide I knew we were all likely to drown within. I called the hospital manager down. I told her to call all of the rest of my evening appointments and tell them we were swamped with emergencies. “Offer to reschedule, (knowing this never works), and ask them to be patient if they don’t want to. Go in all of the exam rooms, (I knew all 7 were filled with people waiting for us), and tell them the same.” I put her on the reception desk and pulled the last two techs to the back treatment area. For three doctors we had 8 technicians scurrying. We also had 17 patients in our building, 7 wanted to crash and expire if you blinked.

I got on the phone with a veterinarian from the Pet Poison Helpline. He was slow spoken, jovial, and the calmness on his side of the line was re-assuring and yet vexingly annoying. “Baclofen is a common toxicity. Have you had one before?” There it came again, “No, I am not an ER.” ‘Don’t kill the messenger’ and ‘be nice.’ I said to myself. He is here to help me. (Does he know that I have 7 other animals trying to die around me?).

“Baclofen is a muscle relaxant,” (yeah, I can see that). “It has a very narrow index of safety in dogs” (Like 1 pill? How about 17?). “Unfortunately, (never want to hear a sentence start with this), most dogs, if they survive, (never want to hear this either), need supportive care for 72 hours to up to 6 days. Many need to go on a ventilator.” (Crap, who has a ventilator? Only the veterinary teaching hospitals, I thought). I kept going. We kept lavaging, hoping, and telling her that I loved her with a gentle pat to her head. I stroked her ears in between her oxygen bag compressions. If she was going to slip away it would not be without my whole heart and soul going with her.

Over the next hour we tried fluids and desperate attempts to stabilize. She was the last patient to leave the hospital that night. I called the local ER to refer. “No,” they had not had this toxicity either. “No,” they didn’t have a ventilator, but, “Yes” UPenn vet hospital does. They had sent a patient last week. Estimate given for this was $18,000 to $30,000. OMG Crap.

I look back on Sophie and I want to cry. I want to be upset about how many times pets get into things we think that they are smart enough to avoid. I want to put up billboards to say, “NO! crate training is not punishment. It is the safest place for your pets to be.” My pups are 4 years old. They are my children. My most beloved. They are also raccoons in autographed collars. They will get into everything if I turn my head for a second. They are trouble. I know that. They are crated when I am at work. They are in a cage at the clinic. They are in a crate in the bedroom when we go out the door. I don’t care if it is 5 minutes or 5 hours. They have been raised this way. Every pill bottle in this house is double locked. A bottle in a closed drawer. Never, ever is it out. Have you ever shaken a pill bottle next to a pet toy? It’s all the same inviting tune.

In a sea of crashing waves, tumultuous and treacherous, I will never forget Sophie’s face. I will never forget that yellow pill bottle with its perfectly intact child-resistant white top, labeled as such. Tattooed with its cursory; “push-down and turn” orange letters. Shrapnel-ed bottle, completely missing any recognizable bottom, or rounded edges. The label chewed, swallowed and obliterated in casual terrorist fashion.

Sophie was sent to the ER at 830 pm. She was transferred without her breathing tube. She coded overnight. She never regained consciousness.

I hope that she heard me. I hope that she knew she was always adored. I hope that she forgives as much as I hope I can forgive myself. Maybe I could have/should have used warmer water in her lavage? Maybe I should have done it just one more time?

My Raffles,, on our daily "dog" walk

Maybe forgiveness holds as much power as intentions? Maybe peaceful acceptance maintains the balance?

Maybe the other 6 will survive. Maybe I am an ER, if only in sheep’s clothing?

My Frippie and Storm

Is Your Cat Safe In Your Own Home?

The most common toxicity we see at the clinic is the inadvertent application of a dog flea and tick product on to a cat. It is the accidental poisoning of the Spring and Summer season.

It happens by accident in most of the cases, as a neglectful oversight of an owner who shares their home with both a dog and a cat. Or, the simple doubtful advice of a product manufacturer who the owner believes is just trying to sell a smaller size for a wider profit margin.

Turns out those warning labels are real warnings.

Those big red letters that state "DO NOT USE ON CATS" doesn't seem to be enough to dissuade people from using it.

Granted, in many cases the drugs and products that we use for people are also used in veterinary medicine. Unfortunately there are a few very very important exceptions.

I get the phone call routinely, it always starts something like this, "Hey Doc, I think that Fluffy is _____,(fill in the blank, truly, the blank isn't the important part), and I gave her some ______, (again fill in the blank, also probably not important I specify the product). Do you think she will be alright?I can't come in until tomorrow."

To which I almost always have to gasp and roll my eyes silently as I try to muffle the screaming "NO!" into a more calm and less threatening voice of, "No, that is not safe for cats."

Unfortunately, in the huge number of cases the cat was given the drug hours, or even days, ago and my heeded warning is too late. 

In the hopes of saving another cat I am going to violate one of the covenants of medicine. I am going to provide broad sweeping generalization guidelines. (Disclaimer provided; Always ask your vet before giving your pets anything! Please?).

1. Charlatans: If it didn't come from your vet don't give it. This includes drugs of any and every type, supplements, vitamins, food, treats, chews, toys, etc. etc. Sound too broad, and slightly paranoid? OK, it might be, but I have seen cats die from every crazy thing imaginable. Like, a supplement recommended by a feed store, a drug store, a big box store, the list goes on. I have seen cats be injured by toys, treats, chews, leashes and clothing. Not to mention urinary tract infections, calculi, strictures, and inflammation from over zealous supplements and inappropriate diets. 
2. Accessories: When you are purchasing something for your cat ask your vet. Collars, although cute, can be functional in alerting an unsuspecting bird of your cats presence and providing a name should they wander. But they can also get stuck around a leg and become a tourniquet or a noose around their neck should your cat get caught in something. Use a microchip, it is far safer.
3. Drugs. If it didn't come from your vet for that specific pet don't give it. This includes every pain reliever, antibiotic, cream of every type. Did  I ever tell you about the client who used hemorrhoid cream for a rectal mass? No, in  fact the cat did not have a hemorrhoid..and  boy did that stuff burn his butt bad!. (People are obsessed with laxatives and hemorrhoid cream. I guess its a big human problem?)
4. Cats and Drugs: I cannot over emphasize how fragile cats are when it comes to drugs. One human sized pain reliever can kill your cat! Don't give them anything without your vets blessing. And, if the box says to "Not Use On Cats" they really do mean it. We had a client  who almost killed both of her cats last year because she thought it was a "suggestion." After spending almost $500 she was angry at us for having to pay for three days of hospitalization, emergency supportive care and all of the numerous drugs it took to save their lives. She was lucky to have been able to walk out with two cats. It was an expensive lesson to learn.

This is a good time to remind us all about the Top Ten Toxins for dogs and cats in 2013, from the Pet Poison Helpline;

Cats: Top 10 Toxins of 2013

1. Lilies: Plants in the Lilium species, such as Easter, Tiger, and Asiatic lilies, cause kidney failure in cats. All cat owners must be aware of these highly toxic plants!
2. Household cleaners: Most general purpose cleaners (e.g., Windex, Formula 409) are fairly safe, but concentrated products like toilet bowl or drain cleaners can cause chemical burns.
3. Flea and tick spot-on products for dogs: Those that are pyrethroid based (e.g., Zodiac, K9 Advantix, Sergeant’s, etc.) cause tremors and seizures and can be deadly to cats.
4. Antidepressants: Cymbalta and Effexor topped our antidepressant list in 2013. Cats seem strangely drawn to these medications. Beware – ingestion can cause severe neurologic and cardiac effects.
5. NSAIDs: Cats are even more sensitive than dogs to drugs like ibuprofen and naproxen. Even veterinary specific NSAIDs like Rimadyl and Meloxicam should be used with caution.
6. Prescription ADD/ADHD medications: These amphetamines such as Adderall, Concerta, Dexedrine, and Vyvanse can cause tremors, seizures, cardiac problems and death.
7. Over the counter cough, cold and allergy medications: Those that contain acetaminophen (e.g., Tylenol) are particularly toxic, as they damage red blood cells and cause liver failure.
8. Plants containing insoluble calcium oxalate crystals: Common houseplants like the peace lily, philodendron, and pothos can cause oral/upper GI irritation, foaming at the mouth, and inflammation when ingested, but severe symptoms are uncommon.
9. Household insecticides: Thankfully, most household sprays and powders are fairly safe, but it’s best to keep curious kitties away until the products have dried or settled.
10. Glow sticks and glow jewelry: These irresistible “toys” contain a chemical called dibutyl phthalate. When it contacts the mouth, pain and excessive foaming occurs, but the signs quickly resolve when the cat eats food or drinks water.

“Every January, we examine our records to see what toxins contributed to the most emergency calls from pet owners and veterinarians the previous 12 months,” said Ahna Brutlag, DVM, MS, DABT, DABVT and associate director of veterinary services at Pet Poison Helpline. “We hope that by sharing these lists, more pet owners will become educated about how to avoid problems and protect their pets in 2014.”

The best thing concerned pet owners can do is get educated on the most common pet toxins, which are listed above, and then pet-proof their homes. However, accidents happen and if a pet may have ingested something toxic, Pet Poison Helpline recommends taking action immediately. Contact a veterinarian or Pet Poison Helpline at 1-800-213-6680. Pet Poison Helpline also has a helpful iPhone application with an extensive database of over 200 poisons dangerous to cats and dogs. “Pet Poison Help” is available on iTunes for $1.99.

Pet Poison Helpline

If you have a pet question or want to share any of your cat photos, antics, or even a cute little story about how precious your cat is to your life you can find me and a bunch of other cat-enthusiasts at Pawbly.com. Pawbly is dedicated to the love of pets and provides free help to any pet in need. Please join us today. Maybe you can save a pet's life with your knowledge and lifetime experience?

Or you can find me on Twitter @FreePetAdvice. Or at the clinic Jarrettsville Vet, in Jarrettsville Maryland.

The Top Ten Toxins in the Kitchen

I found this sticker at the CVC DC conference on the Pet Poison Helpline desk.

I thought it was a good reminder about all of the pet hazards that lie about our homes. Many of which most of us don't realize are toxic to our pets.

These top ten are based on the number of reported cases to the Pet Poison Helpline.

Here they are;

1. Chocolate.
Most people (I think?) know that chocolate isn't good for dogs. Luckily, the most toxic chocolate is the dark Bakers chocolate. And luckily, most of us have the milk chocolate kind in our house. Most dogs will eat only a small amount of chocolate, although I have had a few cases where the dog ate a whole tray of brownies, or absconded and devoured the whole Easter basket. I have dealt with many, many chocolate cases, and thankfully never lost a pup to this..But please keep your chocolate out of reach anyway. AND, if you do need to have the dark chocolate used for baking around put it in a sealed sturdy container way up high on the shelf..And I know everyone out there with siblings already knows that it's always a good idea to to hide your Easter candy!

 

2. Grapes, Raisins, Currants
These are toxic to pets because they can cause kidney damage. I remind my clients to not offer them. I have had many clients admit to feeding frozen grapes, ( a popular summer snack) to their dogs. They had no idea they were dangerous. I once had to hospitalize a small mixed breed dog because she ate a pound of grapes. Thankfully her kidneys were fine. We pulled her blood as soon as she came in for a baseline, then put her on i.v. fluids and hospitalization for 3 days. We also calculated "toxic" dose for her on arrival. Her owners elected to hospitalize her because she was dangerously close to the toxic dose. At the end of the three days we re-checked her blood work and none of her kidney values were any different. So she went home with a lesson well learned by everyone.

My favorite morning cereal.
Granola with raisins!

3. Xylitol/Sugar-Free Gum & Candy
These have become a very big problem. We had never heard of these products 5 years ago, but due to the rise in adult onset diabetes more and more products are coming out with "sugar-free" alternatives. Dogs are very sensitive to xylitol. Whenever anyone calls with a candy ingestion concern we have them read the ingredient list, (or run to the store to get the ingredient list if it to is swimming in the belly of their pet) to see if xylitol is listed. Most of the dogs that we see at our practice has obtained the gum from the owners purse, or from finding it in the car. It's odd to think of a gum as toxic, but it absolutely is.

4. Fatty table scraps
The days after Thanksgiving and Christmas are known as "pancreatitis party-time." Guests and family members alike, in an effort to try to spread the cheer" to the entire family share the high fat festival foods with their pets. Sometimes this is in the form of under the table turkey legs, or letting them lick the grease laden platter clean, or a special holiday meal for the pets too that is a far cry from their normal, healthy, nutritionally complete pet food. For as often as I say "pets and humans share much of the same biology and diseases" we do not share the same diet plan. Humans are able to tolerate a very varied food intake. We can tolerate high fiber cereals, drinks, and foods, and then have a high fat fried dough dessert and be fine the next day. But give your pet one sampling of any one of these and you can easily have acute life threatening vomiting, diarrhea, or pancreatitis. The best advice is to do what we have been forced to do here at our house, and just not invite your pets to the party. I almost lost Savannah to a massive sweet Italian sausage smorgasbord at one of our 4th of July parties. She was taken off the gust list forever at that near fatal episode.

BAD! BAD husband!

5. Onions & Garlic
I think that sometimes I just like to hear myself talk on this topic. It is seemingly impossible for me to try to educate some of my farming clients into believing me about these two veggies. I have many clients who started using garlic decades ago for flea and tick prevention and will tell me every time I see them, "Well Doc, it works, and none of the dogs are dead yet." Another experimental tolerance test decided to be "harmless" because the test subject "is not dead yet."
We had a Shih Tzu puppy a few years ago that was fed minced onion in her food, (for some reason I can no longer recollect). She was brought to us lifeless and sheet white. A blood transfusion and three nail-biting days later she survived, but when I first saw her I wasn't too hopeful.
Here is reason number 4 and 5 to not feed table scraps. Therefore avoiding the inadvertent raisin, chocolate, fatty, onion or garlic in your left-overs.

6. Compost
If it smells bad, (or dead, dying, rotting, decaying, or repulsive), your dog will eat it. (Let me remind you of the tampon eating lab, the underwear eating pit bull, and the millions of feces eating other dogs). (Collective "Yuck!" and "Bleck!" from everyone reading this now). So if your dog has access to your compost they may eat it. Don't try to reason your way out of thinking to yourself, "it is rotting food, he won't want to eat that." Because I promise you if you deliver your vomiting, diarrhea caked pup to us we will all nod our heads and say, "If it smells bad, your dog will eat it." Then hand you an estimate for $500 - $1500 worth of diagnostics and treatment options.

Wren guards the compost pile.
Lots of bugs to terrorize.

7. Human Medications
Over the last two decades the stock of pharmaceutical companies has sky rocketed. We are a country of baby boomers aging, and many of us are on daily medications for all sorts of ailments. We also keep those medications handy because we take them daily, (or even more frequently). As a course of convenience and habit we have gotten a little careless with putting them out of harms way, or making them inaccessible. There are also some dogs who just love to chew to the point of picking up and gnawing on anything hard enough to present a few minute challenge to the palate. Dogs like moderately hard plastic with pills in it. It's the chew toy with maraca like charm.
When these calls come to us at the clinic we most often hear one of the following; "I dropped a pill on the floor and the dog ate it before I could pick it up." Or, "I came home and the bottle was chewed and pills were everywhere and I am not sure how many were in there, or if my pet ate any."
Best to keep your medications away in a pet-proof container, and do not drop them..(that happens to all of us. It's like piranah infested waters in our kitchen everyday of the year).

8. Macadamia Nuts
I was a little surprised to see this on the list. I knew they were toxic but I have never seen one in my practice. Maybe it is more common in macadamia native areas? Macadamias are expensive, so I don't imagine too many people are feeding them as treats to their pups? Maybe they are chocolate covered macadamia nuts (a wonderful gift to anyone returning from Hawaii who wants to give something absolutely mouth watering and yummy to their friends they vacationed without! Or perhaps to the veterinary staff that watched your pets while you were there? Just a small suggestion). Maybe its the irresistable choclate covered macadamia nuts that have placed macadamia nut below chocolate? I bet its the combo that got macadamia nuts on the list..Anyone else have any ideas?

9. Household Cleaners
Dogs are not stupid, but they are creatures of habit, and their sniffers operate on a magnitude of sensitivity that we cannot even begin to comprehend. Most of the household toxicities that we see are dogs who have ingested a cleaner after drinking from a recently cleaned toilet. My best piece of advice is to scrutinize every square inch of your home and property (garage's are chock full of toxins) like you are a mischievous child. Look around your home and ask yourself, "What could your child (or pet) possibly get into that would be dangerous?"
My hope is that you will try to avoid even bringing these products into your home. For us at my home that means the following are banned; rat poisons, chemicals, waste car products (oil, gasoline, anti freeze), and no harmful household items, ( I do use bleach but it is away from pet access). There are many safer products to chose from. And really in many cases things like good old soap, water, vinegar, baking soda, etc, do the job and leave you worry free.
For those products we use that are harmful designate an area your pet would not have access to and place the products in a container your pet could not get into even if by some fluke it gained access to it.

10. Unbaked Bread Dough/Alcohol
Smells yummy, but think about your stomach becoming the bowl to hold the rising the bread? All that fermenting space expanding dough in your stomach is one major cause for severe indigestion and nausea. Alcohol also ferments, and is toxic to liver and kidneys.

Another important reminder to keep all foods out of reach.
I have had many clients tell me that their pet got up on the table/counter and stole food that they thought was seemingly out of their reach. Reminds me of the old Garfield cartoons. That cat, or his dim witted accomplice Odie, maneuvered whole dining room sets to figure out ways to abscond that apparently out of reach lasagna.

Lasagna is to both myself and Garfield a food worthy of manipulation, scheming, and deviousness. I cannot pass it up and I eat it in dangerous amounts. But I know it is made of onion, garlic, high fat, lots of carbs, and everything that is good and holy in the world of vegetarians. I will keep my serving for me, eat every last morsel, and spare my pets the dangers of its deliciousness.
Bon Apetit!

For more information on foods that are dangerous to your pet, please see;
 http://www.petmd.com/blogs/thedailyvet/jlee/2011/aug/foods_poisonous_to_cats_dogs


The Pet Poison Helpline can be reached at 1-800-213-6680
It is available 24 hours a day, 365 days a year. A $35 fee is billed for their services.
Pet Poison Helpline

The stickers were made available by VPI, Veterinary Pet Insurance. 1-866-VET-PETS.

If you are ever unsure what you can and cannot give to your pet you can always call your vet. Or go to our website, Pawbly.com and ask one of us. We are veterinary professionals available to you at no cost. You can submit a question or chat with other people who share your interests. We are here to educate and help you keep your pet healthy and happy for the rest of your lives.

Or visit me on Twitter @FreePet Advice.