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.

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.

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.