That bunny ain't dropping Easter eggs

Years ago, pregnant with my first child and having no veterinary training yet, I acquired a young Nubian goat kid with diarrhea. Fecal testing revealed a protozoan parasite referred to generically as coccidia. A cautious expectant mother, I asked my physician if exposure to goat coccidia was harmful to my unborn baby. When he reported back that goat coccidia (Eimeria spp.) are "host specific" -- meaning goat Eimeria are contagious only to other goats -- I was very relieved.


Flash forward a decade and I find myself, now an animal doctor, doling out this same information to dog owners on a regular basis. Finding microscopic coccidia eggs on an annual fecal float test is not uncommon. Dogs may pass Isospora or Eimeria eggs in their stool, but as with goats these coccidia parasites are "host specific." As I explain this to horrified pet owners, they are relieved to hear it is not contagious to them or their children.

A small sampling of the oodles of eggs
-- coccidia, not Easter -- being passed by two
sick bunnies I saw this month. 

Identifying the presence of coccidia is easy. Now here's where it gets tricky. Remember that coccidia are "host specific." If a dog tests positive for an Isospora-type coccidia it may require treatment because Isospora is a dog coccidia. But if an Eimeria-type coccidia is seen, the dog is simply pooping out the coccidia that a rabbit once pooped out. Quickly differentiating between Isospora from Eimeria based on subtle differences in size or ornamentation takes practice and experience. Nevertheless, seeing as nibbling rabbit poop is a pretty common canine past time, chances are pretty good that many dogs are pooping out a non-canine coccidia.*

Many animals host coccidia without any outward signs of illness. In fact, sickness generally occurs only in very young animals during times of stress. As in my goat kid, coccidiosis may cause severe diarrhea. My yellow Labrador developed screaming diarrhea a few days after we brought him home as a puppy thanks not only to Isospora spp. but also to the stress of leaving his litter. Some of my canine patients--puppy or adult--that test positive for coccidia have unexplained scooting or butt licking without abnormal stools. A short course of treatment for coccidia often relieves all these symptoms.

I recently examined two very young bunnies with diarrhea and lack of appetite. These baby bunnies had been turning up their twitching little noses at hay and pellets for several days, eating nothing but carrots (a treat, not a balanced meal). The day I examined them they had been passing liquid orange stool for several hours. Not having had an occasion to test a pet rabbit's stool before, I was unsure of what I would find. Imagine my surprise when I focused my microscope on the fecal float slide to find hundreds of oval eggs. Coccidia! Eimeria-type no doubt. Treatment with anti-coccidia medication--a teeny tiny portion of the average dog dose--was started immediately, and the owner decided to provide additional nursing care at home.

What fascinates me about this case is not so much identifying rabbit coccidia -- as I explained, we veterinarians see it all the time as an incidental finding on canine fecal floats. It's just that I had never seen so much of it in one place. And never had I paused to think about what the rabbit coccidia might do to the rabbit! The story of these two very sick baby bunnies overwhelmed by coccidia has given this parasite a face and personal meaning to me.


* Cats can be infected with or shed coccidia in their stool as well including various species of Isospora or Eimeria which are not contagious to people. 

We (people) all scream for ice cream!

Over the past year, I have talked about the dangers of feeding certain people foods to pets: grapes, brats, and chocolate have received special attention. Just the other day a client asked me to discuss the effects of feeding your dog dairy products like ice cream.

Now hold on. Before you begin to worry that you've been inadvertently poisoning your pooch with Wisconsin's finest dairy products, let me just say that this particular class of people food is not toxic. Many dogs and cats can and do enjoy a little dairy here and there with no obvious ill effect. But for some pets dairy should definitely be avoided.

First off, a chubby pet should not get people food period. It is just too hard to count calories for your pet when people food is involved. And just as a human dieter would be especially careful with sweets like ice cream, pudgy puppies and cobby kitties should lay off these treats too.

So what about those fit and active pets? Should they shy away from ice cream and other dairy treats? The short answer is "it depends." It may surprise you to learn that many dogs and cats are lactose intolerant. This means a saucer of cream for Kitty or spoonful of yogurt for Fido may result in vomiting, diarrhea or a belly ache.

Shadow, a black lab with chronic digestive problems, is a prime example of how dairy can be disastrous for dogs. When Shadow was rescued from the shelter, she was severely underweight. She suffered from diarrhea, vomiting and had elevated liver enzymes. After repeated courses of medications, she recovered from these ailments, but soon showed up at the clinic with severe pain in her back end. Diagnosed with hip dysplasia, Shadow was treated with a short course of non-steroidal anti-inflammatory medication and started on several long term joint supplements. Like many Labradors, Shadow also suffered from allergy aggravations and periodically needed treatment for itchy skin infections.

Fast forward a few years. Shadow returns to the veterinary clinic now overweight and with her allergies in full swing. Moreover, her owners are worried that her liver problems are back because Shadow pretty much always has diarrhea and vomits nearly every day. Happily Shadow's bloodwork comes back perfectly normal! Her fecal tests show nothing infectious. She appears to be happy and healthy -- certainly she is not wasting away! Based on her history of allergies, we decide to put Shadow on a special hypoallergenic diet. The owners are careful not to give any people food or treats during this time and Shadow's GI problems improve -- but only marginally. Frustrated, we sit down again and brain storm. What could be making Shadow sick?

Finally, we remember her joint supplement, a natural anti-inflammatory derived from milk. Could that be the culprit? Worried that Shadow's hips will act up if we stop the supplement, we nonetheless feel it's worth a try. Her owners stop the supplement but change nothing else. Sure enough, Shadow's vomiting stops immediately. Her stools start firming up soon after. Darn that dairy intolerance! Luckily Shadow's other non-dairy joint supplements are up to the challenge and she is doing fine now. No vomiting, no diarrhea, no hip pain and amazingly even her allergies are less severe this summer.

Shadow's case is dramatic, but it is probably not unique. Many pets eat milk, cheese, ice cream and yogurt. Many pets also suffer from apparently unexplained bouts of vomiting and soft stools. Is there a cause-and-effect relationship here? Perhaps. If you share dairy with your pet and he happens to suffer from frequent gastric disturbances it might be worthwhile to lay off the dairy entirely for a while to see if the belly aches subside. You can always choose a pet-friendly non-dairy substitute for that real Wisconsin ice cream!

Leapin' Livers! Leptospirosis and Other Liver Problems

I am exhausted. And demoralized.

Since late Thursday evening I have been caring for a critically ill terrier on intravenous fluids. Up every couple of hours each night for potty breaks, medicating and TLC. During the in-between times watching "Doggie TV", my closed circuit camera system broadcasting the antics of hospitalized pets to the comfort of my couch (not very stimulating programming...lots of sleeping going on in the clinic!) Just when I thought he was ready to go home on Saturday, he started to relapse.

Denny* is a six-year-old Cairn terrier who presented for vomiting, diarrhea and not eating. Extensive bloodwork and fecal tests all pointed toward acute liver failure. The liver is a very important organ that comes under attack from all sorts of day-to-day insults. Although the liver has hundreds of vital functions, one function is an all around "detoxifier." Everything that passes through the lips of an animal is dealt with by the liver:  bacteria, viruses, toxins, medications. Most of the time anything with potential to harm is effectively neutralized and silently excreted from the body. Sometimes the liver's defenses are overcome and the animal becomes ill. Luckily the liver also has great regenerative potential, so with some intensive care, elimination of the inciting cause, and time, many of these animals recover fully.

Electron micrograph of Leptospira bacterium

Due to his age and vaccine status, Denny was first suspected of having a bacterial infection in his liver called leptospirosis. This organism is shed in the urine of infected wild animals such as racoons or domestic animals like cattle and dogs. The infection is acquired by drinking contaminated water or snuffling around an area where another infected animal has urinated (the bacteria can pass through mucous membranes such as lips, noses and breaks in the skin). Leptospirosis is a zoonotic disease, meaning people can catch it from their infected animal. Some animals become very sick from liver or kidney disease, while others are asymptomatic carriers of the disease, shedding the bacteria wherever they urinate! Yikes! Although leptospirosis is treatable with common antibiotics, if the infection has triggered widespread inflammation in the system the animal may not respond to treatment.

While there is a specific test for leptospirosis, it takes time to run at the outside laboratory and Denny needed treatment immediately. We started him on intravenous fluids to help flush the buildup of liver toxins from his bloodstream, anti-vomiting medications and antibiotics. By Friday evening he was able to keep down water, small amounts of food made for liver failure patients, and oral medications. He was perky and stronger than when he arrived Thursday evening. He even lifted his leg to pee!

On Saturday morning I made preparations for sending Denny home. But by the afternoon, Denny refused to drink and started vomiting again. And his diarrhea returned, a bright orange color signaling continued problems with his liver. Still bright, Denny clearly is not improving enough to go home.

My heart is sinking. It's not the normal progression of things for uncomplicated leptospirosis. Other differential diagnoses are spinning through my mind as I try to make sense of Denny's disease. Does Denny, though not old, have a liver tumor? Does he have leptospirosis or other infection complicated by raging hepatitis? Does he have a heretofore asymptomatic congenital liver disease such as a shunt, a condition where blood loaded with nutrients and waste products bypasses the liver processing center? I'm dwelling a lot on this last one because I know more about his genetic background than I do most of my patients. His parents are my patients too. And they are nearly twice his size!

Portography, a special imaging technique, showing a
large liver shunt. A special dye is injected into the splenic
vein (from right of image) which then travels to the liver.
Here the dye mostly bypasses the liver (middle)
straight back to the heart (left of image).

This size difference worries me because dogs born with liver shunts are generally smaller than their counterparts and may be "poor doers" throughout life. Severely affected animals may show symptoms early on, but some pets find a way to compensate for the disease and may have little to no sign of disease for years. Maybe they do poorly under anesthesia at the time of spaying or neutering. (This is why preanesthetic testing is so important...to catch any early signs of liver problems before anesthesia.) Maybe they are intermittent pukers or have other easily overlooked symptoms of illness throughout life. Maybe as adults they just have some unexplained liver elevations on wellness blood screening and are acting perfectly happy otherwise.

Denny's owner allowed me to speak with the breeder, who has been able to keep tabs on most of her puppies long after adoption. Turns out Denny was diagnosed with a temporary heart murmur in early puppyhood which later resolved. In addition to being petite, Denny has been intermittently vomiting for years, a medical problem unique to him among his canine family members. She also reports that Denny's brother died at age 5 from a vague illness involving his liver!

Because liver shunts require specialized imaging or invasive biopsies for definitive diagnosis, the expense of which is outside most families' reach, we are left with more questions than answers oftentimes. I'm not sure how Denny's situation will resolve. Time is the nearly magical ingredient in so many of these tough cases. Denny's owners are committed to giving him a good chance, so we will continue IV fluids and symptomatic medications for now, buying his liver more time to rest, regenerate and recover if possible.

Potty Training Pointers

I'm trying really hard to follow my own advice this week as we welcomed a new puppy, a 10-week-old American bulldog, to our home. It has been over seven years since I potty trained a dog, but I offer advice regularly to new puppy owners in my practice. These tips have been bumping around in my brain at 4:00 a.m. as I stumble around in the dark after my dog, so I might as well set them down in print.

Tip #1. Feed your puppy meals rather than let him free feed. Doing so makes it easier to predict when the puppy will have to defecate (usually about 30 minutes after eating). So far, I'm failing at this. We've had our dog for less than 3 days. He was used to grazing whenever he felt like it and wasn't eating when I set the food out. However, he is starting to eat more aggressively, so I will start to feed regular meals soon.

Tip #2. Reward your pup for going to the bathroom NOT for coming back to the door. Even though it's inconvenient (and darned chilly), I am wandering around the yard each time my pup goes out to the bathroom. This way I can praise the heck out of him when he lets it rip outside. I've met too many puppies who quickly learn that they get a reward when they return to the house after their bathroom break. They ask to go outside so they can come back in and don't always do their business while they are in the yard. This is because they do not associate the reward with the behavior of going to the bathroom in the designated place. They associate the reward with going out and coming back in. Upon returning to the house they have an inside "accident".

Tip #3. Use a cue word. Most of us probably do this anyway. We want our pup to go potty so we can get on with life. We need to be careful not to distract puppy from his real business when it is bathroom time. No playing until the business is done. Once the pup starts to urinate, you can use your verbal cue one time so he associates that word or phrase ("go potty", "get 'r done", etc.) with the act of relieving himself. Once he's peed and pooped, he gets lots of praise or his training treat.

Tip #4. Walk the pup in a little circle to stimulate defecation. You've doubtless seen dogs of all ages do it, circle a few times in place and then squat to go #2. I find it helps get things moving in the right direction to encourage my pup to walk in a "tight" circle, as if triggering an instinct.

Crate training our puppy

Tip #5. Use an appropriately-sized crate or kennel. A crate is a helpful tool for many reasons. It keeps puppy safe from harm when you can't watch him and protects your stuff from him too. It can be a haven for when pup needs to get away from it all. A crate also helps with potty training. The crate should be big enough to sleep in but not big enough for bed and bathroom because even puppies avoid spoiling their "nest" with their own waste.  Whenever puppy wakes up or you're ready to let him out, get him outside right away to go potty. If he doesn't go to the bathroom, put him back in the kennel for 15 minutes more before trying again.

Tip #6. Do not hit, scold or punish for accidents. It's not going to help. Your puppy is not going to the bathroom in the house out of spite. And even though he may "act guilty" after an accident, he's not feeling guilt. He may be apprehensive because last time you found a puddle he got hollered at. The fact that he made the puddle is not part of the equation. If you catch your puppy in the act, it is okay to startle him with a loud noise. Doing so may momentarily stop the toileting and give you time to get him outside. Some puppies are obvious about needing to go out: they may whine or scratch at the door (EdGrrr always got the hiccups). Others are more subtle, circling an area or sniffing at the floor. You might try teaching your pup to ring a bell near the door when he needs to go out (beware the dog who learns to rings the bell just to go chase squirrels). Another technique is the "umbilical cord trick" where you keep puppy on a long leash inside the house so you notice his signals.

Tip #7. Sometimes pooping in the house is a sign of illness. Not all diarrhea is an explosive, watery mess. My rule of thumb is if you can't pick up the turd without leaving a grease spot, it ain't right. Diarrhea in puppies is extremely common and has many causes: intestinal worms, viruses, bacteria, protozoal parasites, food allergies, stress and dietary indiscretion. Puppies with soft stools often cannot control their bowel movements and will have accidents in the house. Contact your veterinarian and save a stool sample for testing. My puppy is currently being treated for worms with secondary diarrhea. Not surprisingly, we have not seen a single worm in his stool but he tested positive for roundworms on a fecal float. Unfortunately, his diarrhea has put a major hitch in our potty training progress.

I am impressed with my puppy's progress so far. Very quickly he learned the cue "go potty". He still does have urine accidents in the house. This is partly my fault. I am not watching him closely enough and need to crate him more often when I'm busy with other tasks. But even the most rigorous potty training protocol will have slip ups. It typically takes months of consistent effort to completely potty train a puppy. *sigh*

The Skinny on Intestinal Worms

One day last summer my fearless sister-in-law plucked a "slug" from her cat Izzie's bottom and sent me a video of the little bugger crawling around on her desktop. Sarah launched into a tangle of theories of where Izzie could have picked up a tiny slug. I suppressed a giggle. "Uh, Sarah, that's not a slug. That is a tapeworm."


Cats and dogs share our beds and kiss our babies. They also prey on rodents, scavenge dead animals, eat stool and lick their bottoms. Yep. It's gross. Limit the grossness by regularly giving your pet a dewormer. There are more types of wiggly intestinal worms than you probably care to imagine with different types of medicines necessary for each. Here's the low down!


Tapeworm

• Tapeworms are a common small intestinal parasite in cats and dogs.
• Cats and dogs pick up tapeworms by eating infected fleas or rodents.
• Signs of infection are seeing tapeworm segments (e.g., grains of rice, sesame seeds or slugs!) in the stool or around the anus. A fecal float is rarely helpful in diagnosis unless the technician finds tapeworm segments in the stool sample.
• Some tapeworm species are contagious to people and can cause intestinal problems or dangerous neurological disease.
• It may be necessary to treat for flea infestation at the time of tapeworm diagnosis.
• Tapeworm dewormer is notoriously expensive and not included in most heartworm preventatives -- make sure you ask your veterinarian for advice on treating tapeworms.  

Whipworm

• Whipworms are a common cause of large bowel diarrhea in dogs.
• A heavy infestation can cause bloody stool, weight loss, anemia and dehydration.
• Whipworm infections are tough to diagnose on routine fecal floats because egg production is small, shedding is intermittent and the eggs don’t “float” well. Therefore, even with a negative fecal float, your veterinarian may still recommend aggressive deworming if suspicion is high.
• Whipworm eggs can remain hidden in the soil for up to 7 years! That means you must keep your dog on a monthly whipworm dewormer for a very long time to avoid reinfection.
• Whipworm dewormer is not found in most heartworm preventatives, but there are some that include it so ask your veterinarian.

Hookworm

• Hookworms are commonly found in dogs and cats.
• Hookworms feed on intestinal tissue causing blood loss and inflammation in the GI tract.
• Severe infection may lead to anemia, debilitation and even death, especially in young animals.
• Hookworms can infect people (Ewww!) by penetrating the skin or by being accidentally ingested. Infection in humans can cause an itchy rash or inflammation within internal organs.
• A routine fecal float performed by your veterinarian is used to diagnose hookworm infections.
• Many monthly heartworm preventatives also control hookworm infections, especially when used year-round. 

Roundworm

• Roundworms are the most common intestinal parasite of dogs and cats. Assume every puppy and kitten has a roundworm infestation even though worms are rarely seen in the stool. Some animals with very bad infections will pass "spaghetti-like" worms in the stool or vomit. 
• Adult worms live in the intestines depriving the host of nutrients. 
• Common signs may include diarrhea, weight loss, swollen abdomen, vomiting or no signs at all.
• Dogs and cats pick up roundworms from their mother or from infected feces. The potting soil in houseplants is a reported source of roundworm eggs for indoor-only felines! 
• Humans can accidentally ingest roundworm eggs. Infection in humans can cause blindness or organ damage (yikes!).
• Many heartworm preventatives are helpful in treating roundworms, but may need to be used year-round to be most effective.

Heartworm

• Not an intestinal worm, I know! Heartworms live in the heart and lungs of infected dogs and cats.
• Mosquitoes transmit immature heartworms from infected animals to healthy dogs and cats. Even "indoor only" dogs and cats are at risk...have you never been subjected to the whiny nighttime hum and nip of rogue indoor mosquitoes?
• Untreated, heartworm disease is fatal and treatment itself can have dangerous side effects. 
• In dogs, signs of infection may include coughing, difficulty breathing, sluggishness or no signs at all. Cats usually have signs of respiratory disease (similar to asthma), vomiting, lethargy or--you guessed it--no signs at all.
• Heartworm infection can be diagnosed with a simple blood test.
• Heartworm is easily prevented with a variety of safe medications that can be given orally or applied to the skin once a month. As discussed above, many heartworm preventatives do double duty as an intestinal dewormer and some also treat fleas! Your veterinarian can help you sort out the options.

The take home message is that parasites are almost never diagnosed by the naked eye. I hear it time and again: "My dog doesn't have worms. His poop looks normal." You will generally only see worms if your pet has tapeworms or has a really, really bad roundworm infestation! Next, almost all intestinal parasites require multiple courses of deworming medication to be effective. Like fleas, certain stages in the worm's life cycle are resistant to treatment, so you need to deliver the punch repeatedly! Finally, some parasites are contagious to people (especially children and immune-suppressed individuals) making preventative deworming that much more important in certain households.

Your Pet Pooped on the Floor: Why Your Vet Can't Assume It's Behavioral

Here's the scenario. A family adopts two "teenaged" spayed female cats from the shelter. These two teeny boppers are welcomed into the household by the older neutered male cat and the family's dog. The introduction appears seamless. The new kitties cuddle with the labrador and cavort with the cat. But someone has pooped on the couch! And the rug! The owners know it's one of the cats but which one? Is it Mister, latently unhappy about sharing his digs? Is it one of the new kitties, unsure of her surroundings or just reveling in her new freedom to go where she pleases? The poops are pretty normal looking, so it seems like a behavioral issue.


As the family's veterinarian, my first response is "we gotta get a stool sample and run some tests." The only way to diagnose a behavioral toileting problem is to rule out medical causes first.  


"But how will we know whose poop is whose?"

Sometimes that matters and sometimes it doesn't. I like to run the fecal tests on the aberrant stool...one that's softer or yuckier than most or the one that's been deposited where it doesn't belong. The owner of the stool-- when we're talking cats--usually doesn't matter if the problem is infectious or parasitic. Because cats generally share litter boxes we assume that if one of them has worms (for example) they all have worms and all need to be treated accordingly.

Before long I was in possession a fresh sample from one of the new kitties. When evaluating a stool sample for abnormalities, the first test is simple observation. Yes, it's gross, but what does it look like? How does it smell? Sometimes we'll probe the sample with a be-gloved hand checking for foreign material or worms, but 3 out of 5 senses is as far as it goes! This sample happened to be soft but formed with a portion being slightly runny. 

In my veterinary practice a complete fecal test includes a smear, a float and a Giardia "snap" test. These in-house tests identify the most common causes of inappropriate defecation and outright diarrhea.

The fecal float is the test most well known. This checks for parasites such as worms and Coccidia. Coccidia are a species-specific protozoa that commonly affect young or immune-suppressed pets. As for worms, most animals with light worm loads do NOT have worms visible in their stool, so please don't get a false sense of security that your pet is worm-free just because you see no worms! The fecal float helps us identify intestinal worm infestations by showing those worms' eggs. If the worms inside the pet are not reproductively mature or simply not shedding eggs on a particular day, this test may be falsely negative for worms.

The fecal smear helps identify a bacterial overgrowth of the intestines. Every normal gut has a mixture of beneficial bacteria that help digest the food and provide essential nutrients. A wide variety of internal or external factors can destroy this delicate balance and cause abdominal discomfort and/or diarrhea. Luckily most abnormal findings on the fecal smear are not contagious to other pets and people.

Meet Giardia

The final part of the complete fecal test a Giardia "snap" test. This is a highly accurate test to identify active Giardia infections. Giardia is a contagious and zoonotic (i.e., affects people) protozoal parasite that is  common in the environment. The parasite unfortunately also rears its ugly head in shelters and breeding facilities from time to time.

Lo and behold, while the first two tests showed no significant abnormalities, the kitty's Giardia test was an obvious positive. Wow! Even though the kitty's stools have appeared pretty normal, she has an infectious and contagious medical condition. This is the most likely explanation for poop on the couch and rug, NOT a behavioral quirk. 


The good news is this kitty has a treatable medical condition rather than a behavioral problem. The bad news is all the dogs and cats in the house need treatment because of their close quarters. Shed in the feces, Giardia cysts (i.e., eggs) can remain viable in the yard, litter box, bedding and pets' fur and cause re-infection, so a thorough environmental scouring is necessary. The pets were bathed, their bedding and litter boxes washed, and the yard picked up. Each pet is currently undergoing treatment for Giardia to be on the safe side. The owners have been warned to practice good hygiene when handling the animals and to contact their physician for further advice regarding the zoonotic nature of this parasite.


It is said time and again in veterinary school, "You miss more by not looking than by not knowing." Even though the stool appeared normal and there were plenty of possible explanations for the couch poop, we discovered an important medical problem with our thorough test. Thank goodness we checked! And I'm sure the owners will feel the same way after they've completed a hellish week of medicating three feisty felines!

This is Garbage Gut

EdGrrr pilfers a cantalope rind

It may seem like a matter of semantics but vomiting and diarrhea are not normal in a dog. They may be common (depending on the dog), but they are not a normal and simply over-lookable occurrence.

Vomiting and diarrhea are common and vague symptoms of illness in dogs (and cats!). Sometimes, like in people, these problems are mild and self-limiting. The causes of innocent short term GI upset range from non-threatening viruses to eating something that "disagrees" with the pet. On the other hand, vomiting and diarrhea can also signal more serious problems such parasite infestation, pain, infection, organ failure, intestinal blockage and cancer!

The good news is that these latter causes are far less common than the former! Dogs, especially those that enjoy moderate levels of freedom in their day-to-day activities, very frequently ingest things that make them barf. To most dogs, edible is an all encompassing descriptive term that includes decomposing animals, poop from just about any other living thing, and refuse--among other things.

Many times, "dietary indiscretion" results in a short bout of decreased appetite, soft stool, and possibly vomiting. But sometimes "garbage gut" produces such severe gastrointestinal discomfort that dogs require veterinary intervention and medications. In the worst case scenarios, a dog's dining habits may result in life threatening pancreatitis or surgery to remove a foreign body!

What do you do if your dog starts having soft stools, vomits or rejects his dog food? You know your dog best. I find that owners are often a good judge of the severity of their pet's illness (denial is, of course, a powerful and detrimental part of medical cases and can unfortunately delay treatment of serious problems). If you are not sure, it's never a bad idea to call your veterinarian and describe your dog's symptoms.