Hand Holding Anxiety. When You Love Too Much It Costs.

 Hand-holding vs. confident and competent?

Izzy takes a ride with Allie.

It occurred to me that as much as I hope to practice for the latter I see a lot of the former. Maybe I attract it?

Maybe I market it,,, albeit unknowingly.

Questions about intentions from the newest rescue we are helping.
This little one is about 10 weeks old and was rescued from a dump in deep Kentucky.
She had an ultrasound and some questions about the size of our position pillows.

The issue is not that one is better, or worse, than the other. The issue is that I am not as adaptive as I hope to be, or know others hope me to be. The issue is that I am too sensitive, too driven and too insanely compelled to practice for the benefit of the patient and forget to tailor my delivery to the client.

 The real issue is that I forget I am merely an extension of the leashes many avenues, and not the patients only resource to recovery. 

Teddy. TPLO surgery last Wednesday.
All sweetness and a pinch of Border Collie anticipation.

Yesterday was an example of this. Yesterday was Lilly. A bubbly, bouncy curly ginger girl who has had multiple trips to the ER and multiple trips to my clinic for her waxing waning intermittently, self-described as "violent" vomiting and diarrhea. She is owned by two doting millennials. The kind that the vet journals remind me to both recognize and cater to. They are the new generation of my bread and butter. They love their pets in place of having children and they will both spend for them and advocate for them. These are the couples with sets of pet outfits, all personally monogrammed with the family crest, one for each member. One for each holiday, each gathering and always captured in holiday post cards. They have vacations designed around "pet friendly" parameters. They are new parents who jump and take notice at the first sign of illness, discontent, or dismay. They are what I want every pet parent to be, not withstanding the narrow age bracket to remind me I still live in a rural place where people on farms still refer to all species with a prefix denoting "farm use." (The labels can literally kill you around here).

Skylar, also a TPLO surgery Wednesday.
The eyes, they always get me.
I spend a significant amount of my work day reassuring.

Lilly's mom arrived in her work clothes. A clean, dark, pet hair free, (I cannot remember the last time I had one of those outfits, likely never) pencil skirt, with mid-heeled black leather shoes,  and a tight fitting ruched shirt to match. She must work in an office where professional image matters, I think. I have yet to ever live that life,,, (and, yes, there is a side of me that is jealous about that). Compared to my professional attire which included; poorly matched scrubs, upper and lower hemispheres, and not-at-all comfortable, (nor supportive) sneakers with the laces untied dragging behind me swinging to and fro collecting hairball tumbleweeds as they traversed. I was reminded of the hazards by everyone I passed and still was too tired, too painfully arches in agony, to correct them. I have considered adding slippers, or Crocs, (I cannot believe I am here), to my wardrobe as the days get soo long I am reminded my body is decaying. Lilly's mom was intense, apologetic and fretful. Her dog is just over a year old and she has been to the vet a dozen times for the same thing. She is also, in quiet, subtle undertones, worried about the current place her vet bills lie and what the road ahead will look like to for retirement account if she stays on the current path for another decade.

It was 730 pm. We close at 8. I had fit her in after her call at 630 pm begging to be seen for her dogs "vomiting and diarrhea all over the place for the last 3 days." I had been in the clinic all day, 12 hours, and I was,,, done. Toast. And I know it.

I was exhausted. And now I have Lilly in front of me, with her worried mom,, and I am asking myself if I can see just one more case today? I remind myself silently that this, this profession, this day, and yes this moment,, is not about me. There are times, many times, and many days like this, where I am a bag of bones with untidy shoes, urine/fecal stained scrubs and a belly soo dehydrated and hungry I cannot adequately focus, nor separate myself from the clock calling me to close. I had arrived at the clinic at 8 am. I have not had a meal of any sort, nor sat down, nor taken a break to clear my cluttered head. There were 11 surgeries today. Two of which were my own pets. (Let's talk about how difficult that is). Then pile it on top of a day like this. I remind myself there won't be anything left of me to cremate when the burner expires within. I know this. I push my nose deeper into the ground and flex all fours to plow on. 

"Lilly's exam looks fairly normal." I reply. Lilly is now cowering behind her mom. She is drooling with anxiety and really wants me to go away. Pet hair free and upright on her kitten patent leather heels she asks me, "Why does this keep happening? And, how do we stop it?"

It's 745. That answer could take another 12 hours. 

Gunner, using the almost infallible tactic of,
"I'm too cute to ask to participate in an exam" ploy.

"Well, we have never gotten her a diagnosis. We are always treating the emergency and never investigating the in between times that might be leading her to this." I reply.

It's 750 pm. I sit down. I have to. I look up and meet her moms eyes. This was not the answer she wanted.

"Again, thank you for seeing me today. For fitting me in."

"You are welcome. I know you are worried." I suspect she is also worried about needing the ER, having to repeat an overnight stay. The x-rays, blood work, and ultrasound. Never mind the barium study. All of these have been done. And all were normal. 

"Maybe it would be helpful to keep a journal?" I suggest. Something for us to better understand what is happening between her visits? She is a normal weight. Normal size, normal coat. A picture of a healthy dog, but,,,, (bracing myself here),,, she is nervous. Mom is nervous. Is everyone in this household nervous? Stressed? How much exercise does she get? There is a direct correlation between dogs who play, act, and remain happy independent of their parents. I suspect she is a single pet in a perfectly doting home and maybe this isn't beneficial to her gi tract?

I suspect too much love is not what her inner self needs to grow up feeling confident, calm and content with the world she lives in. Good news is there is not an expensive diagnostic for that... just some difficult conversations and a few transitional anti-anxiety medications.. and,, "have you considered another dog?"

Pumpkin is waking up for a mega-dental extraction dental..
very common in older dachshunds.

Lilly is like so many cases I see everyday. I am never sure how problematic a medical problem is when I am not sure that the environment is influencing the clinical signs. Can you love a dog too much? Yes, when you complicate the problems with perception, actions and off setting the balance every life needs. That balance of allowing your pet to be who they are and not needing to live in the shadow of who you are and what you expect them to be. Feeding; the dilemma of feeling desperate to have your pet be happy with their meals, eat as much as you think they should be, and not buckling to offer them anything they find interesting,, too often poor quality, and too often ever changing as we chase the palatability compulsion. When I was in Ukraine rescuing dogs and cats I had a Romanian vet remind me that I needed to chill about the constant feeding concerns for the 12 animals we had transported in the car for the last 20 hours. He reminded me "that in the wild dogs might not eat for days." I wondered to my exhausted, cooked self if that included the stress of a tiny cage shoved in a tiny car running from wars? I loved those animals so much it will be the PTSD I never can shed about that broken place with all of its too many heartbreaking tales.

Induce Vomiting? To Puke Or Not To Puke? The Vets Most Common Question

My Jekyll's early morning yawn,,
although it does look exactly like his "I'm about to yack" yawn.

One of the great mysteries of life is why dogs and cats eat the things they do?

I had a cat last week who ate 16 oz of raisins. Why would a cat eat raisins? (Which by the way is a very valid discussion that you should have with your vet after you figure out how to deal with the potential raisin toxicity risk).

We get a phone call almost daily from a concerned parent whose pet just ate,,, Well, you name it a pet has eaten it.

The question always gets volleyed to the back treatment area where a veterinarian consults with the parent to try to understand the magnitude and repercussions of the ingestion.

Duke uses his Jedi powers to convince me to surrender a snack.

Here's the take home thumb nail version of ingestion;

1. If your pet eats anything that is NOT DOG OR CAT FOOD, or

2. If they eat an ABNORMAL AMOUNT of any food, or,

3. If they MIGHT HAVE EATEN something that is not dog or cat food.

THEN YOU SHOULD,

CALL THE PET POISON HOTLINE, or your vet. Don't wait. minutes count, and hours can kill.

Angel makes a bold statement.
She's tired of waiting for me, even though
today is spay day.

I am all about keeping things as simple as possible. Why? because in times of panic your brain doesn't think properly. So, just reduce the thinking to two steps;

"I think my dog ate..." therefore, "I will call a professional."

OK, after that we discuss the following;

1. Age, size, breed,
2. Amount of product ingested,
3. Type of product ingested,
4. When it was ingested,
5. Any complicating pet factors, like disease, medications, etc.

Please remember to look at your home and possessions as a place that needs to be protected from a toddler who wanders and ingests arbitrary items. Don't leave out any medications, choking hazards, or dangerous items laying around. Everything in your pets environment that they have access to is a a potential "chew on and swallow" item. Don't leave stuff accessible to them, they will disappoint you, and I would argue that it is your fault, not theirs.

OK, so you have a pet, you have stuff, you therefore need a pet emergency kit.

Your emergency pet medical kit should have 3% hydrogen peroxide. You should call your vet, ER, or Pet Poison Helpline BEFORE using this. Some products should not be vomited!!!

Lia gives a sad face.
She's here for a very minor boo-boo, sore left foot.

Here is my simplified list of things to induce vomiting for;

1. chocolate. I would first emphasize to call the Pet Poison Hotline and discuss the amount and type of chocolate. It takes quite a lot of chocolate, and it usually has to be a very dark  bakers chocolate to cause problems. 
2. plants, that aren't supposed to be eaten.
3. clothing like hoisery and synthetic materials.
4. plastics, unless it is thick and might have hard edges that could damage the esophagus.
5. medications unless they are in liquid or gel cap form.

Here's what you DO NOT induce vomiting for;

1. petroleum products
2. glues
3. bleach, cleaners, most liquids

And lastly, DO NOT INDUCE VOMITING IF IT HAS BEEN LONGER THAN 2 HOURS SINCE INGESTION.

Bella, always a charmer..

The best way to get your dog to vomit is to give 1 tsp per 10 pounds of hydrogen peroxide. The maximum dose is 3 tbsp. You can do this twice about 10-15 minutes apart. If this isn't working head to your vets office or the closest emergency clinic.

Cats, well cats are another story. Cats are better on a case by case basis. And why did that cat who eat 16 ounces of raisins? Well, who knows, it's a cat. But there isn't a safe way to induce vomiting in a cat at home. You need a vet for that.

My sweet girl Magpie.

And, as fate would have it, as I began writing this blog I had a client call today. They had just left the office from their examination, got home, went back to the project he had left, dropped a bolt on the floor and POOF! his dog swallowed it. Without knowing what kind of bolt it was I told him to have him vomit it up. Three tablespoons of peroxide later the bolt was back on his floor. See these blogs do make a pets life better.

Related Blogs;
Signs That Your Pet Needs Emergency Care

Is Your Cat Safe In Your Own Home?

PassOver The Easter Lily, Protecting Your Cat

And if you can't find the answer there, you can ask me, and a whole bunch of other pet experts at Pawbly.com. We are an online platform dedicated to helping people take better care of their pets. We are free to use and open to anyone and everyone who cares about pets.

You can also find me on Twitter @FreePetAdvice. Or at the clinic, Jarrettsville Vet where I help pets everyday.

Grass Eating, Vomiting, Car Sick Puppy

One of the best parts of answering Pawbly questions is learning about the ways people perceive their pets and their pets actions. I also love to answer the questions! Here's the question that I received today. It is insightful because I know many new parents are concerned about their puppy/dog getting car sick, and many people don't recognize just how important and concerning some of these behaviors can be.

"Hi, my daughter just got a puppy from a shelter. She is 5 months old. She keeps wanting to outside to eat grass. Earlier today she got sick two times in the car. She also got sick in the car when she was bringing her home. Will eating the grass hurt her or will it help her to vomit?"

Here was my answer; Let me know what you think;

"Thanks for your question.

There are a few things to discuss.

I would like to know how long you have had your puppy, and if she has been to the vet yet? I would also like to know if she has had a fecal check? (she might need more than one). I always worry about intestinal worms with puppies. Especially if they are vomiting or having diarrhea. 

I tell my clients that "most puppies come with worms, it is very common, and worms come with the puppy package. So expect them, check for them, and treat for them."

I am unclear as to whether the vomiting is related to the car trip? Or, if she is vomiting without it being related to the car? Many pets, especially puppies get car sick due to anxiety about being in the car, and the motion of the car. I always recommend taking your puppy with you in the car as often as you can so they get used to the car, used to the motion of a car, and over come their anxiety associated with the car.

Getting car sick and vomiting because of being in the car, but then stopping vomiting after you get home or to your destination is fairly common. But, if your puppy is still vomiting after the car ride stops then I am concerned that we have a puppy who is nauseous.

There are many things that can make a puppy nauseous. The best way to try to determine the triggers for nausea are to visit your veterinarian and start talking.

I am also concerned about your last statement; "Will eating the grass hurt her or will it help her to vomit?" Eating grass can cause a few things. Pets can pick up the eggs of the worms that evolve into the intestinal parasites that can be dangerous to the health of your puppy. Also, I have seen dogs that have eaten so much grass that the stomach becomes a vat of fermenting green discomfort. This grass becomes a stomach full of un-passable, un-movable, obstruction. It can get stuck in the stomach like cement, except this cement is fermenting,. causing their belly to be stretched to the point that the grass is stuck and may eventually cause the stomach to rupture. These dogs are miserable. They are trying to burp to expel the fermenting stomach gas, trying to vomit, to relieve the pressure in the stomach and feeling terrible. I have actually had to do surgery to remove grass from dogs because their stomach is bloating. Bloat is incredibly painful and can be fatal.

So, I don't want you to think that she should be eating grass. A small amount of grass eating is likely to be safe and may be normal for a curious puppy who investigates the world by tasting it, but I am concerned that she is eating grass because she doesn't feel good.

I hope that I have encouraged you to try to identify why she is vomiting, why she is eating grass, and that you will have a meeting with your vet soon to help your puppy feel better.

If you would like to discuss any of this, or see a veterinarian and you live close to us at Jarrettsville Vet we would love to help.

Best of Luck, and here's to wishing you and your puppy a long, happy, safe life together!"

I wanted to add a few other relevant observations. The dogs that lick obsessively (think about carpet, rugs, blankets, etc), graze or eat grass frequently, lick their lips frequently, or burp, might have either nausea, allergies, indigestion, or reflux. All of these behaviors should be discussed, researched, and treatment options offered to keep your pet happy and healthy. 

I don't always discover the reason why a pet does these, but I always try to curb it. I have performed too many gastrotomies (open up the stomach to inspect and empty it), exploratories (open the abdomen to treat or inspect the organs), and passing of a tube into the esophagus to remove trapped air and ingesta (can be gastric dilation and/or gastric dilation with volvulus (GDV)) to ignore these signs. And even if I cannot figure out the reason they are licking, chewing, swallow, etc. is happening I know they have a reason and I know I need to try to solve it before it becomes a problem.

Here is a dog that we treated a few months ago that had bloated from eating too much grass.  He was very lucky that his mom knew what to look for and knew what was going on. She had just picked him up from a boarding facility a few town away and she immediately noticed that he was distended in his abdomen, trying to vomit (nothing was coming out because there was too much pressure inside the stomach to allow it to empty), and reluctant to move. If she hadn't gotten him to us as quickly as she did he likely would not have survived. She had lost her first poodle to this disease, and she knew exactly what was going on. As soon as he arrived at the clinic we tried to decompress his stomach by passing a stomach tube. The stomach tube is used to remove the fermented grass from his stomach to help relieve the pressure. It is also how we treat choke in horses.

This is what I call a stem to stern incision. It extends from the diaphragm to the pelvis.
It is required when you need to get a very large dilated basketball sized stomach out of the abdomen so you can open it, inspect it and remove any other contents.

The table is tilted with the head down so we could pass a tube from the mouth
to the esophagus to the stomach. 

This is what fermented grass looks like after it has been removed from the stomach.
There is about  3 liters of foul bright green ingesta.

 One last note. After the abdominal exploratory surgery was completed we performed a gastropexy to try to alleviate the chances of a GDV occurring again. This tacks the stomach to the abdominal wall to anchor it, so that even if the stomach dilates it can't twist.

For more information on GDV and gastropexys see the links below;

http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/GastricDilatationVolvulus/

http://dogs.about.com/od/dogandpuppyhealth/qt/GDV.htm