Category Archives: Dog Emergencies

Emergency situations and conditions affecting dogs

Emergency!

The past two weeks have seen the launch of our 24-hour service, meaning that the clinic is now open round the clock, with a vet available any time of the day or night, much as we are used to having in the UK.

With two new vets enlisted to take it in turns being on overnight on alternate weeks, backed up by a night nurse and our existing night animal care staff, the service officially kicked off at the start of the month and has so far proven to be popular. There have, inevitably, been some adjustments to the way the rest of us regular day staff operate, such as some new shifts and a few later than expected or usual finishes, but we’re all optimistic that once the initial adjustment period is complete it will actually make our lives less hectic and stressful.

One of the changes has been that naturally we need to do a handover with the night vet going into the day shift, and so one of the vets is assigned to the hospital for the week. This basically means that they come in for an earlier start at 7am, which gives them an hour to effect a detailed handover with the night team, before being in charge of checking, planning, updating and generally doing what is required by the various in-patients. Given that our wards are usually pretty well populated, this can result in quite an intense shift, with the hospital vet then consulting from about half ten until their finish time at 4pm. The early finish clearly makes for a nice end to the day, although that does assume that they get to actually walk out at four, which so far I don’t think has really happened.

The other vets come in as usual for an 8am start and crack on as before with admitting surgeries and seeing consults, or getting on with the various procedures booked in for the day. Trying to get our full compliment of two hours of lunch (sounds like a lot but bear in mind we are in from 8am to 7pm) is still a challenge, although when it happens it really does help to set us up for the afternoon/ evening consulting period, which is usually pretty busy. One change that certainly seems to have occurred is that the couple of hours leading up to 7pm have become a lot busier, with more of what we can refer to as the genuinely ‘sick’ animals booking in. As such the final couple of hours have been, on the whole, very busy. With the consults being booked up to, and even beyond 8pm, it does mean that when 7pm, and hence our scheduled home time, comes round it is usually the case that we either have results pending for a case we have seen in the afternoon, or there are simply more clients waiting to be seen than would be fair to leave the late vet to deal with solo – after all, we’re all nice people and we’re not the kind of individuals who can knowingly walk out leaving both clients and our colleagues delayed and inconvenienced. That has meant several late finishes which, again, I am sure will even out as the new system becomes established and when we get some new vets on the team.

Last night was a particularly intense affair, with both an in-patient requiring a blood transfusion at the end of the day – never a quick process – and a ‘sick, off-colour’ dog coming in which turned out to have some seriously nasty business going on internally and so required surgery that evening, including, again, a blood transfusion. As such we all stayed on until gone 10pm, well into the night shift, although sustenance was provided by a much welcomed, and oh so chocolatey cake, that one of my colleague’s clients had dropped off earlier.

The cases in question, for those of you with an interest in such gory details, were a cat with a severe immune mediated haemolytic anaemia, most likely secondary to tick-borne disease and not helped at all by being FeLV positive. A lovely little young cat, she was presented the evening before with, again, a history of just not being herself and was found to be very pale. Her bloods revealed the true extent of her predicament, as she was sadly diagnosed with FeLV (Feline Leukaemia Virus) and had both a severe anaemia, with a red blood cell percentage very much on the borderline of needing an immediate transfusion, and a raging high white cell count. Aggressive treatment was started but the response was not enough to prevent needing a blood transfusion last night.

The second case was that of a geriatric dog who, as with the cat, was presented with a history of just being quieter than normal. Again, pale and lethargic, bloods revealed a low red cell count and concerns about possible internal bleeding were confirmed by ultrasound, as we found her abdomen to be full of blood due to a ruptured splenic mass. As such, the options were starkly binary: euthanase or operate to try and save her. Her owners opted to try and save her so after bringing in a blood donor we took her to surgery and removed her spleen, complete with nasty, ruptured splenic mass which was the cause of her abdomen being full of blood. The surgery went well and at the time of writing the patient was recovering well, although is certainly not yet out of danger.

So there we have it…. the next chapter in the vetty adventures here in Dubai, complete with a new 24-7 element. Things should continue to be very interesting and, I daresay, remain intense.

If your pet does need to be seen overnight, then Al Safa Veterinary Clinic, on Al Wasl Road, Dubai, is now open 24 hours, 7 days a week, and can be contacted on +971 (0) 4 348 3799.

Vet Lessons

Various chocolateMany of you found discussing a real veterinary clinical case interesting last month and so here’s a seasonal problem that we get faced with pretty much every year during the festive period: chocolate toxicity. Some of you may already be aware of the fact that chocolate is actually toxic to dogs, but for lots of people, clients included, this is something that they have no idea about.

Dogs being dogs will generally eat anything and everything, and with lots of advent calendars and selection boxes around in December, it is more likely that they will eat chocolate and get into trouble. So, get your teeth around this case and help reduce the number of dogs we see on Christmas Day 🙂

This month’s festive topic is….

Chocolate Toxicity

Virtually every Christmas, and Easter for that matter, we get phone calls from worried owners who report that their dogs have managed to devour a load of chocolate, either as a result of being typical dogs and seeking out food, or by inadvertantly being fed the stuff by a well meaning individual, normally a child who thinks its fun to share their chocolate with the family dog. It is not a great surprise to learn that the vast majority of these cases I have seen are Labrador Retrievers, such is their almost manic love of food.

Now we all know that chocolate can be bad for our waistlines but the thought of one of our favourite treats actually being toxic seems like a completely alien concept. The reason chocolate is of concern in dogs is due to a substance called theobromine, which is a natural component of chocolate, with dark chocolate containing more than milk and white chocolate. Theobromine is actually toxic to humans, if consumed in large enough quantities, but it is the fact that dogs metabolise it much slower than humans which makes it significantly more likely that we see signs of toxicity in them.

The clinical signs associated with chocolate toxicity generally include nausea, vomiting, diarrhoea, collapse, seizure, abnormal heart rate and rhythm, and increased urination. When we get calls from owners who say their dog has eaten chocolate the main questions we ask, before advising them to head straight down to the clinic, include:

  1. How much, in terms of total weight, of the chocolate do they believe their dog ate? This helps us to determine whether the amount of chocolate, and thus theobromine, is considered to be at toxic levels.
  2. What type of chocolate was it and what is the percentage of cocoa contained (eg 70%). Darker chocolate contains more cocoa, and thus theobromine, than milk chocolate. Knowing the percentage of cocoa and the amount of chocolate eaten allows us to accurately determine whether toxic levels have been consumed. This relies on us also knowing the dog’s bodyweight, which we double check when they come in to see the vet.

Some of the dogs we see who have eaten chocolate will be bright as buttons, whilst others will come in collapsed and showing obvious clinical signs of poisoning. These dogs are usually the ones who have either eaten chocolate several hours before, and so had time to absorb the theobromine and develop signs associated with it, or who have eaten very large quantities recently. I normally perform a clinical exam on the patient, take a fuller history from the owner, confirm the answers to the questions above and ask to see the packet of the chocolate, assuming the owner has brought it with them, which you should really ask them to do. I then weigh the dog and give the Veterinary Poisons Information Service (VPIS) a call, as they are a fantastic source of advice and guidance on currently known toxic doses of various substances and advice on ideal management and treatment.

If the dog has eaten chocolate less than 2 hours before we see them then we make them sick, usually by giving an injection of apomorphine, which is a powerful emetic (makes animals vomit). This often works within five minutes of giving it and the result is usually a nice, sticky, sweet-smelling pile of vomit for all to enjoy – lovely part of the job!

If it has been over 2 hours since ingestion then it is often too late to make them vomit, as most of the chocolate will have been digested and the theobromine absorbed. Whether our patients are made to throw up or not, we usually take a blood sample to check the dog’s kidney parameters, as the kidneys can be affected by theobromine. We then start the dog on a drip, to keep the dog well hydrated and help flush the kidneys through. If the dog will eat, which many will, then we start feeding them bland food with activated charcoal in it every few hours. The charcoal acts to bind and absorb any chocolate still in the dog’s intestines and prevent it being absorbed into the blood. We continue with this measure until we see the dog passing black charcoal in it’s faeces. Sometimes the toxic effects of theobromine can take up to 72 hours, or 3 days, to show and so we usually keep the dog on fluids for at least 24 hours, but often longer, and recheck the kidney values regularly, in case we see any evidence of late kidney effects. As a result, the cost of treating a case of chocolate toxicity can be very high, something that pet owners may have trouble appreciating and understanding, especially when what they can see is an apparently fit and healthy dog.

If there are any other, more serious signs associated with chocolate toxicity, such as seizuring, then we deal with those. These measures may well include:

  • Vomiting & Diarrhoea – we give gastro-protectants (medicines which help reduce acid production in the stomach and protect the lining of the intestines), anti-emetics (medicines to prevent the dog feeling nauseous and throwing up). We may also offer kaolin-based gels, which help to reduce diarrhoea and make the stools firmer.
  • Cardiac (heart) arrhythmias – we monitor the dog’s heart rate and rhythm with an ECG and give medication to correct any abnormal rhythms if they occur.
  • Seizures – giving anti-seizure medication, such as barbiturates (eg diazepam) is the method for dealing with seizures.

Assuming that the patient responds well to treatment, and we catch the case early enough, then they often make a full recovery and can be sent home. It is vital that the owners are well educated about the dangers of chocolate in dogs in order to significantly reduce the chances of toxicity happening again.

Pet Blood Bank – Great to get involved

Chris the Nerdy Vet with Joseph, a proud pet blood donor
Me with a happy blood donor, Joseph the dog

I had the pleasure on Sunday of being involved in an official capacity with the Pet Blood Bank, a fantastic UK charity that collects blood from volunteer dogs, with the blood then being processed into packed red cells and plasma, which is then made available to vets around the country for use in emergency situations and for major surgeries.

The organisation was fantastic with the session overseen and administered by a fantastic team from the Pet Blood Bank HQ based in Loughborough. The whole day was relaxed – for donor dogs, owners, and even vets! My role, as an official vet, was to health check the donors, including taking pre-screening blood samples, and to decide whether, in my professional opinion, the dogs could indeed go through to donate. Every dog I saw was an absolute picture of health, and so well behaved, that the entire day just seemed to whiz by in a happy, healthy blur of activity. The criteria for dogs to donate is quite strict, and rightly so, with dogs having to meet the following criteria:

  • be aged between one and eight years old
  • weigh more than 25kg
  • have a good temperament
  • never have travelled abroad
  • be up to date on all vaccinations, and not have been vaccinated within the last two weeks
  • be fit and healthy
  • not be on any medication, other than routine flea and worm control

Before the dogs can donate they have a blood sample taken, and their packed cell volume (PCV), which is the percentage of the blood that is made up of red blood cells, and total protein (TP) are measured. If they are both within certain healthy limits then they can be cleared for donation. Every dog I saw passed with flying colours! Each dog then donates 1 unit of blood, which is equivalent to about 450ml of blood, and the actual donation stage only takes about 5-10 minutes. The great thing is that every dog then gets to tuck into some tasty food – the equivalent, I guess, of our ‘tea and biscuit’ – after their session and gets a goody bag, complete with toy, to say a huge thank you for their donation.

The great thing is that the blood that is donated goes to help vets save lives in real practice – something that as an emergency vet myself, I have been involved in first hand. Donor blood truly does save lives! The wonderful thing was that the day saw experienced, repeat donors turn up as well as dogs and owners for whom this was their very first experience, and everyone had a good time doing something worthwhile.

If you would like to find out more about the work of the Pet Blood Bank, including how to get involve yourself, then click here to visit the Pet Blood Bank website.