Episode 163: First Aid Basics for Dogs

Tony Johnson, DVM, from the Veterinary Information Network hosts a great discussion about first aid basics for dogs, including first aid kit essentials, basic triage, when to see the vet, and more.

This episode is taken from a webinar - to see the accompanying video, click here.

Transcript

Nicole Engleman  00:04

Welcome to the Good Dog Pod. Join us every other Wednesday when we discuss all things dogs, from health and veterinary care, to training and behavior science, as well as the ins and outs of Good Dog, and how our platform can help you successfully run your breeding program. Follow us and join Good Dog’s mission to build a better world for our dogs and the people who love them. Hi, everyone, and welcome back to another episode of The Good Dog pod where we discuss all things related to canine health research, how Good Dog helps breeders run their breeding programs, and so much more. I'm Nicole, the Breeder Community Lead here at Good Dog and your host for this week's episode. Today, we're joined by our guest Dr. Tony Johnson from the Veterinary Information Network. And he'll be talking all about first aid basics for dogs, including first aid kit essentials, basic triage, when to see the vet and more. As always, this is a topic heavily requested by our community. So we're so excited to bring it to you today. And we hope that it will be a helpful resource for your breeding programs, and just something to help you keep your dog safe in general. So with that, I'm gonna pass things over to Dr. Johnson.

Dr. Tony Johnson  01:15

Thanks Nicole for the intro. Let us jump into first aid for your pet. And then working in the ER, I see a lot of things that people do at home that are helpful and can limit patient's pain and morbidity and mortality. When they come into the ER I do see some times where things are made worse, you know, wrap is put on too tight or fractures aren't stabilized before coming in. And that causes soft tissue damage. So hopefully there'll be some little pearls here that you can use and store away if you have to help a family member with a pet or if God forbid one of your pets becomes ill too. This is going to be kind of long ish. And I'll try and not go over too much. I'll try to go quickly. But Special thanks to the folks that Good Dog for putting this on and making it a podcast so we can listen to it. Just a little bit of anatomy stuff. If you have to call your vet and describe something it's good to know what body part it is. A lot of people get the ankle and the knee confused and the wrist and the elbow confused. So you can see right there where the bones are. The true name for the thigh bone is the femur. A lot of people know that. Knee we tend to refer to as the stifle, and that's the proximal tibia, that's the knee there, it's kind of tucked into the tissue of the thigh. The hip is the pelvis, spine is made up of all the vertebrae, scapula is the shoulder blade, that's also the shoulder is kind of up in the tissue on the dog. And it's a little hard to identify sometimes. And then the technical name for the ear lobe is the pinna, that big flop part.

Dr. Tony Johnson  02:45

So vital signs if you have to contact your vet and try and figure out is this an emergency? Or is it not or if there's now a whole bunch of online and phone based ones where you can get advice on is it an emergency, or not knowing just some basic vital signs is important. I'll go through how we get each of those. Heart rate, the best thing is to put your hand over the left side of the chest, count the number of beats in 15 seconds and multiply that by four that gives you beats per minute. Respiration, watching the rise and fall of the chest wall, the same thing count over 15 seconds multiplied by four. Mucous membrane color is often the very first thing that we check when we're triaging a patient that comes into the ER and you can check this at home, make sure you do it in good light. If you're doing it in dim light, you're gonna get misleading results. So have a nice flashlight or natural light, you want to lip and check the actual color. And then we check something called capillary refill time, which is kind of a pretty crude estimate of cardiovascular function. And that's where you press on the gums or the lips until they turn white. And then you let go and count the number of seconds it should turn back to a healthy pink within about two seconds. It does say here if it's less than one second to call a veterinarian, but that's super dependent on the patient. So really, we're looking at color and just pinks back up after you press on it. Within two seconds. Pulses, I'll show you where to check a pulse similar to heart rate. We do have some patients that will have heart arrhythmias where the heart's not beating normally. And the pulse rate in the heart rate can actually be different. So that's in the femoral artery, which is in the inside of the thigh. And then body temperature, also another one that we very commonly will check on almost all of our patients and rectal thermometers are the way to go. We do occasionally use an ear thermometer. If they have anal or rectal pathology, or it's painful, but those digital rectal thermometers are the best. And then in Canada, they typically use centigrade. In the US we usually use Fahrenheit. I'm not sure how many of you guys are aware.

Dr. Tony Johnson  04:48

Okay, so for respiratory rates, if you can observe your cat or dog while they're sleeping, that's the best way to get it because they just saw a squirrel outside or they just saw the mailman drive by, they're going to be kind of keyed up. Respiratory rate, if you are going to try and get a set of vitals, is probably best to do before you're doing other things and getting them excited like the respiratory rate and even the heart rate, after you take a temperature are probably going to be significantly higher. So try and observe a dog rise and fall of their chest while they're sleeping or at rest. And then to me respiratory rate is such a variable number, that the effort they're putting into it is actually more important than what the rate is. And I'll give you some normals in just a sec. But is the dog really struggling to breathe or the cat? Are they taking short shallow breaths or taking deep breaths? Is there any noise when they're doing it? We see some older dogs, usually labs, that will get a condition called laryngeal paralysis that happens in warm weather. And they make a very kind of classic, high pitched rattling noise as they're breathing in. So if you ever happen to notice anything like that, that's really important information to get to your veterinarian. And cats do not pant or open mouth breathe for any reason; dogs pant to blow off heat. Cats in general, when they do that, are in some form of distress. There are some of them that get a little bit stressed out on the ride into the hospital, they'll overheat, they come in open mouth breathing, but they calm down within a few minutes. If you have a cat that is in your house that is open up breathing, that's typically a sign that something is going on that bears evaluation. So here you can see a technician. Her hand is up under the left side of the chest wall. And if you take the dog's leg and kind of move it back where their elbow contacts the chest wall is usually about where the heart is. So I'd encourage you while you're sitting, you know, watching Golden Girls on TV tonight with your dog, just slip your hand up under the left side of their chest and then count the number of beats in 15 seconds, multiply that by four, and that's gonna give you the BPM or beats per minute. So that's a good thing to know how to do.

Dr. Tony Johnson  06:53

Mucous membrane color, like we said, here's a nice happy, healthy pink dog. So this is in good lighting conditions and you can see the color, a very good indicator of cardiac and respiratory function. We talked about capillary refill time being less than two seconds. So here's a dog that is very, very anemic, his gums are white. So this would be blood loss, hemorrhage, ineffective bone marrow, red blood cell destruction, that kind of thing. Or shock dogs that are in heart failure and cardiogenic shock their hearts not literally pumping the blood out to where it's supposed to go. So sometimes you'll see white mucous membranes, that can be kind of a purplish bluish tinge if the dog is having difficulty breathing. Brick red, some dogs just particularly Dobies tend to have really dark mucous membranes, it's just a breed variation. But dogs that have had certain kinds of toxicities. Dogs with fevers, dogs that have septic shock, they often have their blood vessels be inappropriately dilated and can have these kind of brick red mucous membrane, so get to know what your dog's normal color is. And then you can tell if there's any variation. And then this poor guy is what's called icteric. That's a buildup of bilirubin in the blood. It indicates not just liver problems, like we could see some dogs that have what's called hemolytic anemia, where their immune system is destroying their red blood cells. And bilirubin is a breakdown product of red blood cells. So if the liver is overwhelmed and can't get rid of those because the immune system is chewing up all the red blood cells, they can become very icteric like this. And you can see that the white of the dog's eyes is also yellow. The other place that we will look is inside the pinna inside the floppy part of the ear and sometimes on the belly. And this is when the tissues are actually stained with bilirubin. And that's a sign that you need to get it in and get an evaluation.

Dr. Tony Johnson  08:49

Pulses the femoral artery, so we were taking the heart rate by putting our hands up on the left side of the chest and just feeling the thumps of the heart. Here, the femoral artery is inside the thigh. And you can unless the dog is really, really overweight, in general, you can feel this very well. And if it's possible to correlate the pulse with the heart rate, that will give you good information. But that's kind of the AP course in first aid. Either the pulse rate or the heart rate is good info to get to your vet however you want to do it. But same thing, just put your finger inside the thigh until you feel something pulsating and count the number of beats and 15 seconds multiplied by four.

Dr. Tony Johnson  09:31

Body temperature, rectal temperature is the best way to go. There's always a little bit of body temperature variation between patients but normal for dogs and cats is between about 99 and a half and 102.5. So those are the normal ranges. I had a patient last week. It was a hot day. It was in the ER. You know maybe the person's AC was busted or something and the dog came in with a temperature of 104 but we let them chill out for a little bit and it had gone down to normal within about 20-30 minutes. And then cats, I use the same range, you know, roughly 100 to 102.5. So heart rate normally varies by size and breed, smaller dogs tend to have slightly higher heart rates, big dogs, and well conditioned athletic dogs tend to be a little bit on the lower side. But generally speaking, 70 to 160 heart rate is more or less normal, it should be lower at home than it is in the hospital, typically because it's a stressful place to be, see dogs with, you know, technically slightly high heart rates. But that's because they're scared of the crazy dude in the white coat coming at them. Respiratory rate somewhere between 15 and 30 breaths per minute. But again, remember effort is going to be way more important than the respiratory rate. And then as we said 99.5 to 102.5 temperature. Vital signs of cats are very similar, but cats tend to be a little bit higher in terms of heart rate up to 240. A stressed out cat is sort of normal ish, respiratory rate about the same temperature rate about the same, a little more challenging to get a temperature in a cat sometimes. And one note on taking temperature. Sometimes if you don't get it in far enough, or it's even in a little ball of feces, you can get an abnormally low artificially low temperature. So if it comes back 96, either your pets are in a whole heap of trouble or you just took the temperature of some poo, so you might need to redirect and try it differently.

Dr. Tony Johnson  11:25

Poisonings are a common thing that we see in the ER. And a lot of the poisonings, we don't know what it was they got into, you know, was it the compost pile out back? Was it the spilled medication, you know that somebody dropped on the floor? Did they just move into a house and there was a rodenticide rat poison tucked behind the fridge that the dog found. So we treat a lot of unknown poisons. But there are two major animal poison controls. This one is run by the ASPCA. And the other one is called the national pet poison helpline. I don't have their number here, I should add that in. But if you just Google pet poison control, they charge 50 or 60 bucks for a console that is well worth it. A lot of times we'll have owners call at home and start the case and get a case number. And then when they come into the hospital, I can call and talk to a poison control specialist without any additional fees, and they will see it through the whole life of the case. So they're very good at dealing with unknown poisons, they're very good at telling us, Oh, you know, that's not a critical amount of whatever drug he got into, or no, this is a potentially dangerous dose, and here are the steps you need to take to get him through it. So I really am a big advocate of pet poison control.

Dr. Tony Johnson  12:36

Some common toxins that we see a lot of people worry over much about chocolate, you know, I think I've had to treat maybe 10 actual chocolate toxicities in my career, and I don't think I've ever seen a dog die from it. So it's really you know, you do want to get it out of them. But it is not the lethal thing that it's meant out to be, unless it's a massive dose. And there's kind of a sliding scale. Milk chocolate, it takes roughly a pound of chocolate for 20 pounds of body weight of milk chocolate for it to be anything more than just you know, vomiting and diarrhea. But as you get on to darker chocolate, baking chocolate, then you can really have a problem if a dog steals a whole block of baking chocolate off the counter. That could be an issue and mainly we'll see hyperactivity, heart arrhythmias, and then possible vomiting, seizures, and sometimes pancreatitis. And it's because of the active ingredient that's called theobromine that our human systems tend to laugh off, it acts like caffeine in their system. So, you know, if your dog gets into a significant quantity of chocolate, it's best to bring them into the hospital and make them vomit. Rodenticide, the very, very common one, the anticoagulant, rodenticides, the ones that cause bleeding, have been taken off the market by the FDA, but they allowed companies to sell their stock, so you'll still find it. It's been replaced, and we had an antidote for the anticoagulants, it was vitamin K, we would give them plasma if needed. But it's been replaced with one called bromomethylene, which I think is far worse. Because it has no antidote, it can cause delayed neurological signs four or five days after they get into it. And they put it in these little baits that are meant to attract mice, so they taste good. And they also tend to be in areas where mice and other rodents will be creeping around the house like downlow, behind the fridge. And so they're kind of at the level where their pet lives. So we see these all the time. And it's important, if you're buying them and putting them out to know what you're putting out. What type is it, try and put it in a place that absolutely positively your pet can't get. And if you do have to bring your pet in. This goes for any toxin at all. Try and bring in the container and the container may be chewed up. But sometimes we can get a SKU code or something on it. So anytime you have to bring in a pet that you suspect a toxicity, try and bring in whatever the container was, your jar of pills, the thing of Advil, you know the poison that you put out, that kind of thing.

Dr. Tony Johnson  15:02

Other common toxins food poisoning dogs love to get into garbage all the time. When the weather is warmer here, there can be some really funky things growing in there. There are a lot of molds that can produce neurotoxins. They're called tumorigenic mycotoxins and they can cause seizures, tremors, twitchiness, and you know, just your general sort of food poisoning of a dog that ate something that's gone bad can just be gastrointestinal signs, vomiting and diarrhea, that usually responds pretty readily to some fairly simple stuff. But in Portland, where I practice for a while, it is very common to see dogs getting into compost bins, and they would come in just twitching and trembling, and in severe cases, seizures, and you have to support them through that. Also, if dogs get into the garbage, it's very common that they can get a foreign body impaction and get something like a blockage in their GI tract. So that's where X rays and maybe ultrasound are helpful to differentiate that. antifreeze. Luckily, the word has gone out, we don't see this nearly as common as we used to 1520 years ago, but the active ingredient is ethylene glycol. Ethanol is the active ingredient in my evening cocktail. ethylene glycol is what's in there, it tends to taste sweet to pets, but some companies will put a bittering agent in it so it doesn't taste sweet. It can initially cause vomiting, seizures, CNS central nervous system depression. And patients that get into this initially kind of act like they're drunk, they're stumbling around. It's also a very common sign that they're dribbling urine. And it can lead to renal failure or death, but it's often delayed. So you do have a window cats, unfortunately, you have about an hour. And once they start showing clinical signs, and once the kidney values are elevated, your options get way limited, you can still try something high end like dialysis. But what happens with the ethylene glycol is the ethylene glycol itself is not toxic, it gets metabolized by the body into a toxic substance that then forms crystals in the kidneys. And they almost literally create a stone. So if you can prevent that formation, they can just pee out the ethylene glycol. Without metabolizing it you can have a good outcome. But unfortunately, once they're showing signs of elevated renal values, things really take a turn for the worse. So luckily people know that there are now non toxic antifreeze that are propylene glycol, I wouldn't call it non toxic, it can still cause problems. But it's not nearly as deadly as ethylene glycol. We also see a ton of prescription or over the counter medications never ever, ever, in your whole life ever give any amount of Tylenol to a cat because it will kill him dead. Or her dead cats are unable to metabolize it in the same way that we do because they lack an enzyme in their liver. And it just causes all sorts of mayhem. And I've seen case after case of somebody who's like well, my cat wasn't feeling well from condition A and so I gave him a Tylenol. And now not only do we have to deal with the deadly Tylenol toxicity, we have to deal with whatever made them give the Tylenol in the first place. So acetaminophen and Tylenol are the same thing. It goes by a different name in Europe, which is escaping me right now. But Advil, ibuprofen, they're very sensitive to it, dogs in particular, I don't think I've ever seen an ibuprofen cat, but they do like to chew up the models. And at the appropriate dose, it can cause renal failure, a little lower dose than that can cause stomach issues including ulceration, and at really high doses it can cause seizures and neurological issues.

Dr. Tony Johnson  18:29

Antidepressants or seizure meds can cause issues with dogs, we're seeing a few more problems with certain skin creams. There are hormone creams, there are anti cancer, skin creams that sometimes people put on and then they'll pet their dog and the dog will lick it off. And that can cause issues and blood pressure medications. But really kind of any prescription or OTC medication beyond that can be potentially a problem. Common plant toxins so everybody around Christmas gets all hyped up about poinsettias, they're really not toxic, per se. They do have some crystals in the leaves and in the flowers that can cause a little bit of oral upset or GI upset stomach ulcers if they ingest a lot of it. But you can kind of set your mind at ease over poinsettias. They're really not that bad lilies, which have been recognized maybe the last 1520 years can be deadly toxic to cats, the whole plant including the water that it's in, there are websites that will there's a whole bunch of different Lily you know, Stargazer, tiger lilies, that kind of thing. There are some that have the name lily in them that are non toxic, but really just any Lily, I wouldn't pick it into the house. So vomiting, lethargy, where they really become a problem is causing renal failure. So, you know, when somebody gets a bouquet of lilies around Easter, the cat chews on a leaf. It can take just a little tiny bit and can be in renal failure inside 24 hours. They can be treated you know, I've had to scope some cats to get really pieces out of the stomach. You can put them on IV fluids in the hope that whatever the toxic principle As will be flushed out, but just be very careful with lilies and sending lilies to your friends. You may want to inquire if they have any cats in the house.

Dr. Tony Johnson  20:08

So raisins, I am not a raisin fan. I think they're just grody. Little grapes with the life sucked out of them. But they can be toxic to dogs grapes can as well. And the really problematic thing with raisins. Because when this first came out, people were like, I've been throwing grapes in my dog for years. They love a good frozen grape in the summer. What are you telling me? The toxin is unknown. Nobody knows what does it it causes kidney failure, like so many toxins do. And it can be just a little bit just a few grapes or raisins, or they get into trail mix that has raisins. And some dogs are fine. They've been eating grapes for years, there's no issue. So it may be regional variation in them. It could be a fungus that is in one area, but not the other. Nobody really knows. And so 20 years ago, somebody said My dog ate some grapes, I'd be like, well, he's gonna have diarrhea. Now I tell him, Well, you should probably come in, we should do some blood work put them on IV fluids. I had one case of a beautiful lab. This was in Maryland that I think ate a whole bunch of grapes that came in it went into what's called an uric renal failure where the kidneys were shut down to the point that they just stopped producing urine and the guy had a airplane. So he flew the dog up to the world's largest Veterinary Hospital in Manhattan where they did dialysis and the dog did okay. But that was a very expensive bunch of grapes. So just be on the lookout for that grapes and raisins.

Dr. Tony Johnson  21:30

Alright, let's talk a little about vomiting and foreign bodies. So dogs think the world is edible until it is proven. Otherwise, they will eat some crazy stuff I have seen, you know, Bart Simpson squeaky toys I scoped to watch out of a dog's stomach, why a dog would need to watch it Oh, but foreign bodies are just a super common thing. They're sort of the scourge of the ER and you know, we see so much gastroenteritis and vomiting and diarrhea in the ER that trying to figure out, do they have something that's causing a GI obstruction or a blockage or not. And it is not easy. You know, sometimes we'll repeat radiographs a few hours later to see if ingesta has moved through. Ultrasound can be pretty good at picking it up. And we think we do sometimes if there's continuous vomiting, and we don't have another reason for it, is to go in surgically and explore and about two times out of three, we will find that there's a foreign body causing a blockage. So some foreign bodies like whatever this little metal thing is show up on an x-ray, clear as day. So that one right there that tack or whatever it is, is in the stomach, we would either scope this or do surgery to get it out. This one is a rubber ball that kind of got deformed in there. So these are foreign bodies that would pretty clearly show up on X rays. And I would say I have a pretty good chance of getting that rubber ball out with the scope and not having to go to surgery. But these are the obvious ones, things like rubber, cloth hair ties, those things tend to not show up on X-rays, X-ray beams go right through them. So that's when we look at the intestines for signs of obstruction. So gas or material that's not passing through. Sometimes we send them off to a radiologist to do it. Sometimes we'll put them on IV fluids and watch him for six, eight hours and repeat rads. Sometimes we'll do barium, there's just a whole bunch of tips and tricks that we use when we're trying to figure out if there's a foreign body. So let's say you've got a dog or cat that has vomited. And you call your vet. And you know, they take some X-rays, and it's clear that there's no foreign body. What should we do? They may ask you a few questions like How long has it been vomiting, if it's two episodes, we may try and treat that at home. If it's five days, that's definitely something that needs to be seen. But for a simple case of gastroenteritis, where let's say you see your vet and they have X rays and the pets feeling okay, not feeling ill, we try to let the GI tract rest and do what we call NPO or meal for us for a few hours. So fast pet from food and water for 12 hours. Now again, this is assuming a young, healthy animal with no pre-existing medical conditions that has one or two or three episodes of vomiting and it's feeding well after you do this fasting period offer little tiny bits of water, they're not going to get dehydrated, they will catch up. But you just want to introduce water or clear liquids like Gatorade first, and watch for any nausea. So if you just put a giant bowl of water down, I guarantee you they're gonna be like, oh water, I haven't seen this in days and suck it down. Their guts are probably still upset, it's going to come right back up and perpetuate the cycle. So little bits of water depending on the size of the patient, watch for nausea. And then the easiest homemade bland diet is either boiled chicken breast and rice, boiled hamburger and rice and yes boiled hamburger sounds gross but it's just protein without the fat or fat free cottage cheese, cheese and rice and then offer that in meals three, four or five, six times a day. Whatever your schedule tolerates and a couple of teaspoons or tablespoons at a time, depending on the size of the pet. And then if they're doing okay with that for two or three days, then you can gradually mix whatever your bland diet is, with their regular food, transition for another two or three days and get them back on their regular diet.

Dr. Tony Johnson  25:18

Alright, bloat, a lot of you have probably heard of bloat or unfortunately experienced it, we'll talk about what that is. The medical name is gastric dilatation, and volvulus. And this is where the stomach fills up with air, and then flips over on itself. And then once it's flipped over, it tends to kick off its own blood supply, it can drag other organs with it like spleen, you can have internal bleeding, you can have necrotic stomach tissue, it can really be a mess. So it is life threatening. So I'll give you the signs of bloat. And if you see them, head on into your vet bonus points, if you give them a heads up call beforehand. So the clinical signs, one of the big ones, is unproductive retching. And I'm not even going to talk about how the disease happens. Because nobody really knows, nobody knows if they fill up first and then twist if they twist and fill up, if both happens, but we'll just talk about what the signs are unproductive, wretched. So this dog is making this horrible vomiting noise, but it's not bringing up anything except maybe a little foam. And this is because their stomachs are usually huge. And they're feeling that they have to throw up but they cannot throw up. Because their stomachs are twisted. It's kind of like tying a knot in the bottom of a balloon all that air can't get out. Often they're either agitated and pacing because it hurts, or they're just going into shock and become very weak and lethargic. Often if you check their gum color. Again, in good light, they will be very pale or even sciatic which is blue. A lot of them are salivating or drooling because they can't swallow saliva. And then some of them, most of them will have kind of a bloated appearance where their abdomen looks distended. People are like oh my God, his abdomen just blew up. If you sort of flick it with your finger, it can sound like a hollow beach ball. Sometimes I have been tricked because there are some dogs that have such a deep chest that most or all of their stomach can actually be up in the ribcage and their belly doesn't actually look that big, but you will catch it on an x-ray. So here are some of the breeds where we'll commonly see it. I think Great Danes are the poster child for it, about 40% of them will have an episode of bloat at some point in their life. And these are mostly large breed deep chested dogs. A lot of savvy owners and breeders are recommending what's called a prophylactic gastropexy. And that just means we go in often at the same time as a spay and tack the stomach down to the side of the body wall. To prevent the twist, it doesn't do much to prevent the bloating, you know the stomach filling up with gas. But it will hopefully, in most cases, prevent it from twisting. I've seen a few failures of that, but most of the time it will. And this can even be done with a laparoscope so it'd be done with little cameras that they put inside the body. So here's kind of how it goes, you're looking on the left side there, a normal stomach, the tube up at the top is the esophagus, the tube coming out the left side is the pylorus where food goes into the intestines. And in illustration, two, three and four, you can see that pylorus is gradually drifting over to what would be the left side of the pet, the right side of the illustration. And it's kicking off the esophagus. So it's kind of swelling with gasses that happen. So when it twists over there, that's when all the madness happens. So here's what we see, when we do an x-ray on a bloated dog, I don't have a good one, I have a normal to show you. But we often look for what's called the Popeye arm. And that's that big black wormy thing that you see. So the pylorus, which is the outflow for the stomach, is that bulge at the very top, that should be at the very bottom. So this is now the stomach that has bloated. And one thing that we look for is this ridge of white stuff like this tissue on an x-ray and black is air. So we'll see a ridge and we call this compartmentalization. And this is just sort of a funky way the stomach folds. But if we take an x-ray and see this then there really are only two options at this point and one is surgery and the other is euthanasia, the chance of recurrence is 90% without surgery. So even if you are able to get this shrunk down, there is a very high chance that it could recur. I have, a few times, supported them with fluids and then had them go to the owner's regular vet to have the stomach attack down, but you don't know what condition the stomach is in. And that may be a patient that dies a very slow, painful death that has a rotting stomach in there.

Dr. Tony Johnson  29:36

So typically, I like to give owners lots and lots of options for care from the super Cadillac Mayo Clinic plan, on down to just what will ever get us through the night. But I really kind of firmly believe we have basically two options with GDV. All right, let's talk about diarrhea. I can't wait for all the questions from this. So an episode or two of diarrhea in an otherwise young and healthy pet is just what happens, you know, my dogs get loose stools for a couple of days. And maybe we'll do a bland diet, but extreme diarrhea, uncontrollable diarrhea, extended diarrhea, really can cause mayhem with the electrolytes and hydration status, particularly for young and geriatric patients. So that's something you would want to get looked at. Sometimes if it's just a bout of diarrhea, and maybe you go see your vet, and they're like, Well, you know, it looks good. He's not dehydrated, let's try this, that and the other. For diarrhea, there could be a whole bunch of other things that are causing it. So sometimes we'll see diseases of the GI tract like cancers, or inflammatory bowel disease. There are a certain number of parasites that can cause this are some really nasty ones like hookworms and whipworms. And so if you can try and bring in a fecal sample to your vet, they may or may not use it. And then some kind of toxin, ingestions, or ulceration of the GI tract can lead to diarrhea, if you're noticing that your pet stool is black, that's often a sign that there's bleeding high up in the GI tract, and that digestive blood turns black, and it's called melanin. So that can be an important thing for your vet to know. You just have to differentiate that from a stool that's been laying out in the sun, because that tends to also kind of darken as well. So this would be if your pet is having black diarrhea, or stools that you have seen come out that are black, then that would be an indication to have them checked out. And I'm not going to go into OTC medications for diarrhea because they keep changing the formulation. And I used to say something like Kaopectate was okay, but then sometimes they'll put an aspirin-like derivative in it. And they can change these formulations without letting anybody know. So Kaopectate used to be safe. But sometimes they'll put these salicylates in it that can be toxic to dogs and particularly cats. So there's really not a lot of OTC stuff that I recommend the laboral or some of the other ones that are OTC can be used, but they should be used under the direction of a veterinarian, so call your vet and see if they're cool with that.

Dr. Tony Johnson  32:01

So here's some dog restraint that we use in the clinic. A nice little Aussie who's being restrained for a blood draw, or a catheter placement and you can see these poor technicians man getting down my back couldn't do this anymore. You can do this up on a table too, but a lot of dogs are more comfortable on the ground. And even though I'm getting older it's harder for me to get up off the ground. I tried to do my physicals down at the dogs level, if I can just so they're less freaked out. How to move a patient that is injured so a bed sheet for a dog that is down and can't get up would be a great way to do it. If you have a dog that is kind of lying on its side and you're concerned about a back injury or a neck injury. A big piece of plywood if you happen to have it around would work, you can even gently duct tape them to the plywood board. I had one where the people were camping and their dog got injured and they tore down one of the campsite signs that said like the legs over here, the bait shops over here and prompted to log in on that cat. Sometimes a towel or a pillowcase is okay. Trash Can Lid can be used for smaller dogs, we're just something that's going to hopefully not let them tweak their back too much. I don't know about leather gloves. But we use leather gloves in the clinic for cats, where we really have to do the work. And these are very thick leather gloves, I think your standard kind of household ones probably wouldn't work. Just in case you think you need to have a muzzle. This is just some gauze. But you can use any sort of length of whatever. Tear up an old towel, a bedsheet and if you need to move a dog that is injured and the dog is trying to bite you as they will sometimes you can just gently tie it around the muzzle, bring it back up around the ears, and then tie it there either with a square knot or with like tie your shoelaces and that can just be snipped off in the clinic. If you do have a dog that you know tends to be aggressive at the vet, I would invest in a basket muzzle just something you can slip on at home, it's going to make everybody feel much safer. I have worked with a guy who lost a finger after a dog bit a veterinarian, and they do happen, they are serious. In the vast majority of cases a muzzle is not going to hurt a dog and it's going to make the staff feel much safer and feel like they can do the close and work with the pet that needs to be done to diagnose and fix the problem. So nothing wrong with the muzzle as long as it's used appropriately. So use caution when you're handling a sick or injured pet. They're not going to act the same way that you're used to. You're going to have to find something else if you have a pet with respiratory difficulties because a lot of dogs are mouth breathers and that will just really, really stress them out. And then leave it on the shortest time possible. We have some people that will leave a dog unmuzzled in the room when the vet comes in. They put the muzzle on and we try and get it off as soon as possible. All right, dealing with a hit by car. Every hit by car really can be an emergency. There's so much kinetic force that is transferred to the dog that in a car versus dog situation that car is almost always going to win. Even if your pet seems fine a whole lot of things could be happening under the hood collapsed lungs ruptured bladders, tears in the diaphragm. So we usually take some X-rays, I've had patients that have been hit by a car, check that okay even had X-rays, okay, that six months later we find out they have a diaphragmatic hernia, which is a tear in the muscle that separates the abdomen from the chest, and the stomach or liver has moved up there. So some of those can even escape X-rays. Never underestimate an animal that is scared or hurt, even your own, they may not recognize you at that point, they may be out of their mind with fear or pain. So always assume that there's a possibility, you will get better. Just a few words on fractures, there's a picture of a really nasty pelvic fracture, that one is involving the joint and would need surgery, we do see some pelvic fractures that just heal with rest, but that one right there would have to be surgically repaired. So try and muzzle your patient or restrain them in as comfortable and safe of fashion as you can. Don't try to set the break or align the bones or any of the crazy stuff that we see in movies and unless it's been prescribed for your pet, don't give any oral medications like Tylenol, Advil, ibuprofen, acetaminophen, any of that stuff. So why do pets get fractures, trauma would be the number one so hit by car trauma hit by lawn mower or what have you. We see some dogs that are out running and they'll step in a hole and break something in their foot or their tibia. There's something called a pathologic fracture, which is very hard for people to get their heads around sometimes. And this picture on the right is a dog that has a bone tumor in the proximal tibia, so just below the knee, and bone tumors tend to eat away at the bone and make it unstable. And then they just have to land wrong, where we often see this as a dog that jumps out of the back of a car and the bone is weakened and they just go down and start yelping. And if you take a picture of those you'll often see the bone is very weak, and it looks like it's been eaten by a boss or termites. So that's called a pathologic fracture. And that's typically related to a tumor in that area. And most bone tumors are these very, very nasty things called osteosarcomas. But there are also fungal diseases like blastomycosis that can go to the bone and erode the bone.

Dr. Tony Johnson  37:15

All right, heatstroke, it is summertime, I hate seeing pictures like the one on the right dog locked in a car. I had my car in the sun, it's a black car. And there's a little app that tells me what the temp is in the car. And it was 125 degrees after being in the sun for about an hour. And that's going to literally cook all the proteins in your body, you will be medium rare at that point. So 15 minutes and an unventilated car at 80 degrees ambient could kill your pet. So some symptoms of heatstroke, they're often just flat out, they're often panting like crazy. The GI often pays the price first and these guys and they just blow out their whole intestinal tract. So you'll often see explosive diarrhea, with blood if it's really bad, they can have seizures because the central nervous system and the brain literally all the proteins are just denaturing, those are bad cases, coma and loss of consciousness. So you know cars are the obvious one and I'm sure all of you here, do not do this. But even on a hot day a dog outside doesn't have adequate shade or water exposure that can do it. Definitely don't leave them in the car. Large breed dogs have a lot of what's called thermal inertia. It's hard for them to blow off heat when they get it. So monitor large breeds and in particular brachycephalic dogs. So these are your Frenchies, your English bulldogs, your pugs. They have an abnormal heat exchange mechanism. I grew up with pugs. I love them. They're wonderful dogs, and Frenchies are cute as all get out. They cannot handle hot, humid days. So even something like a walk on a hot humid day can do them and then just limit exercise. Dogs often are lacking in a sense, common sense and they will just keep charging around and going crazy at the park long after they should stop. So try and just watch your pet on hot, humid days, shade and water when they are outdoors. If you think your pet has heatstroke, take a rectal exam because it's sometimes good to know what it is out in the field if you can do it, but don't delay, move your pet to hopefully indoors where there's a C if you're going to go into the vet have the AC on in the car, and if the temperature is greater than 104 That's when I would definitely come in but you can also cool them down with cool water don't use towels because those tend to turn warm and insulate them for a long time. Conventional wisdom was I don't do ice water baths because that causes a blood vessel constriction and actually keeps the heat in that is actually since by human medicine been found not to be true. So ice water immersion is okay. It is a faster way to get the temperature down although it's technically kind of hard to do but whatever, just cool them down, put a fan on them and get them into the vet hospital.

Dr. Tony Johnson  39:59

Okay, just a little bit on injuries that cause bleeding and exposure of whatever. This is a picture of a patient being bandaged in the hospital, you're hardly ever going to have all this stuff around. Although I did have a patient with a tail laceration a couple of weeks ago that had a very good, almost medical grade bandage put on at home with all the right stuff. So it's nice to have some clean cotton cloth around to absorb the blood. If you have stretch gauze like that brown stuff in your first aid kit. That's very nice for wrapping around something like an extremity. You want to be able to get your fingers under it, though, you want to be able to get at least one finger under without it feeling tight, because the last thing you want to do is change the laceration on a foot, four foot amputation, which I've seen happen many times pantyhose, which I don't know maybe a lot of people don't have those around anymore, but you can use that to secure things if you want. Ace bandages are fine. The only thing I would say is if you have a large open wound, you want to put something absorbent and sterile over the wound before you put the bandage because you don't want a bunch of cotton and stuff sticking to the wound. So feminine hygiene pads are very nice, because they tend to be nonadherent. They're very absorbent, they tend to be sterile. And so that's a good thing to put on a big wound before you're going to wrap it with gauze or cotton. If you have a fracture, you know I was telling you before, don't try and stabilize it or whatever. But you can use a rolled up magazine or rolled up newspaper. If you can do it safely. That's where you know this is kind of dicey. But to give some stabilization to a fracture, usually of just a four leg or maybe any of the feet incorporated into your bandage just for transport, that's a little hard to do. And then if you have the tape of any kind, putting it around your bandage and then maybe a little bit adherent to the hair so it stays on would be good. So this is what we will do in the hospital if we're going to do something like a support bandage over a cast or sometimes for minor fractures. We'll just have the support bandage do it. They're thicker than the other ones. And they have lots of rolls of tape on them. So here's one, this is what's called a Robert Jones. So this is very large and is even bigger than the support bandage. And you can see this when there's a rolled up newspaper or rolled up magazines incorporated into it and then wrapped with white tape. So this would be just a temporary thing to keep that led from swinging around this porosity whoever this is was having a rough day haven't bandages put on and all that you can wrap those around some rolled up newspapers to give some stability to it.

Dr. Tony Johnson  42:32

Alright, we're nearing the end and I think we are just about good on time before we do questions. So some things to have in your home first aid kit you may want to consider one or all of these some patients that get pretty grody. They may have blood on them. I've had lots of patients come into my ER that have human blood on them. So rubber gloves roll gauze, and one of those quick activating ice packs if you have a strain or a sprain can be handy, a rectal thermometer. A clean t-shirt can be kind of handy for staunching blood flow. If you have a patient that has wounds around the thorax, you can just slip that over their head and down over their body and put their front legs through the armholes. Duct tape is great for just about everything you know if you have a bandage that you're going to put on and you're going to put some rolled up magazines for stability, just duct tape around that puppy will cut it off when you get to the ER Datadyne is an iodine based antiseptic. That's good for swabbing on small wounds. Guys squares very handy again for small wounds, towel or a blanket for transport or just for security, either strips of fabric to make a muzzle or long piece of gauze that she does good for transportation Telfa pads which are non adherent, they're kind of like the thing that's on a band aid they don't stick to wounds but they'll still keep them dry. And then a muzzle if you think your pet is going to need it, some blunt scissors or bandage scissors, again for small wounds, probably nothing on the face because they're going to lick it off. But for like a little wound you may want to put some Neosporin or something on it, you know anything smaller than a dime, that's probably okay. cotton socks are good for wrapping up the feet, saline iWatch just like the same kind of stuff that you would use on your eyes. If a dog gets a bunch of dust in his eyes or has goofy eyes to just wash up some of that stuff before you go in a Spanish material. Very nice to have again for putting on the outer layer of a bandage that blue stuff there's what's called vet rap. A lot of you guys have probably seen it. It's a very elastic bandage material that can be used on the outside of advantage to keep everything nicely in place. So if you haven't, it's a good idea to have a little first aid kit. We have kind of a random one of stuff that I've gotten from various hospitals I've been at. Put together for our cats and dogs in case they ever get into an emergency. And then American Red Cross, I think this book is still out there but Bobby Memento has a nice pet first aid thing. There's tons of resources online but just be careful with what you look at because there's tons of bad info and wrong info and you know, stuff like that. So just like anything else online Caveat emptor buyer beware Add that is it. So thank you guys very much. Thank you, Mikel, for getting us rolling and arranging this.

Mikel Delgado, PhD  45:08

That was amazing. I learned so much. We're funny. I laughed out loud several times, just so you know. We've gotten a lot of nice feedback from the audience and a couple questions. I have two burning questions. One is when people are doing reps at home, you mentioned being able to stick a finger underneath the rat, can you explain why you don't want to wrap too tight.

Dr. Tony Johnson  45:30

So I have seen lots of cases where people will try and avoid a vet visit by being like, oh, I can bandage this or if you put a wrap on too tight, it can reduce circulation to the area. And if you reduce the circulation from the veins, that causes swelling, and then the swelling makes it tighter under the bandage, and that can cause more swelling. That then cuts off the arteries and you can lose a limb. And we just saw a dog a couple of weeks ago, a long-haired dog. The owners' kids, being kids, put a hairband or a rubber band around part of the ear. You couldn't really see it because the ear was all hairy. But the dog lost about a third of its ear because it started shaking his head and blood and pus went everywhere. But yeah, a tight bandage can make you lose a limb. 

Mikel Delgado, PhD  46:18

Thank you. And when you were talking about household things that pets can ingest, you didn't mention one thing but I thought it might be worth talking about which is just you know, a lot of states now have medical marijuana or legal marijuana, snacks and edibles. Do you see that regulating your practice and what I mean? I think what I've heard is that a lot of people are too embarrassed to say that their dog ate a pot brownie. Yes, your advice?

Dr. Tony Johnson  46:42

Well, one fess up, like we're not the DEA, we're not going to rat you out. You know, unless it was intentional. I've seen some college kids blow pot smoke in a dog's face and that I would get all up in their grill about but if your dog eats your edibles, one, it's typically pretty easy to treat. And we just put them on fluids and feed them Doritos and they're okay. And we're not going to call the cops on you. They typically do very well. However, there have been two dog deaths in Colorado where it's the like, this is not your father's marijuana. This is the new potent strains. So very, very little risk, but the risk is there and definitely fess up if you have it around.

Mikel Delgado, PhD  47:19

Okay, great. Thanks. I mean, you said like bringing the packaging of the like that decide and everything. So, I mean...

Dr. Tony Johnson  47:24

It's legal in Illinois and like I have some edibles downstairs. I keep them away from the kids and the dogs, but it happens and it happens pretty commonly.

Mikel Delgado, PhD  47:31

Yeah. Okay. We got a question from Sandy. She wants to know about aspirin marketed for dogs. Is that safe? And if so, when?

Dr. Tony Johnson  47:38

I'm afraid I don't take any questions from people named Sandy. I'm sorry. It's just a personal thing. I have. Sandy. I'm kidding, Sandy. I don't know, aspirin can be used for dogs carefully. It does have more propensity to cause GI ulcers than some other things. There even are published doses for Tylenol and Advil for dogs. Problem is it's so easy to go from a therapeutic dose to a toxic dose. If a dog is on another anti inflammatory like remedy il Dara Max. If they're on steroids, like prednisone or get steroid shots, you definitely cannot use aspirin. But I think it's okay. I think we have way better medical alternatives. But it's okay.

Mikel Delgado, PhD  48:20

We have it's not really a question but more of a comment. And maybe you have some insight. One of my male dogs just had an i hope i pronounced this correctly, intussusception.

Dr. Tony Johnson  48:29

Yes, intussusception. Yeah, you got, you got it. Okay. It's a very hard word to say and spell.

Mikel Delgado, PhD  48:33

Okay. They said, I've never seen or heard of something like that happened before. Very expensive surgery, but he's doing well now. Is that something that you encounter in your practice? Can you explain what it is?

Mikel Delgado, PhD  48:43

Okay. And we've got a question and you kind of I think you've touched on this a little bit, but thoughts on kaolin pectin for diarrhea, I bought some marketed for dogs over the counter for my first aid kit and I'm wondering if it's even a good idea.

Dr. Tony Johnson  48:43

In intussusception, your intestines are a tube, right? You're basically a doughnut. And when the motility gets jacked up, a segment of intestine can actually it's like a telescope collapsing, it can sort of swallow the next segment down the line. And it literally is just like a telescope poster and a long tube to this. Yes, succession of tubes nesting inside each other. And that causes functionally an obstruction. We often see it in dogs with GI parasites, so hopefully that person's dog had either a fecal or was dewormed because there's always an underlying cause. We see it sometimes in Parvo puppies, where their guts are just on fire, the motility is all messed up. And you know, Parvo is hard to deal with to begin with, and then you throw in, in a perception. So yes, they're very common. The signs would be abdominal pain, you can often feel these, it feels like a big honkin sausage in their abdomen. They're typically very painful. And you have to surgically go in to evaluate, is the bowel still healthy? If the bowel is still healthy, then you and telescope them. And you kind of tack them down to various places. It's called enteroplication surgery. But yeah, those are common.

Dr. Tony Johnson  49:59

I love it. If it's marketed for dogs. You just have to make sure that it does not have salicylates or anything beyond pale and pectin and maybe flavoring. So what does pectin is kind of like what makes jello jello? Well, in addition to the cantaloupes and crap that they put in it, but pectin is like what makes fruit Jam Jam, so it'll absorb the water and make the stool less watery. Kaolin does the same thing that tends to kind of coat the intestines and kind of sooth it, that there is a product that I like that at the clinic I moonlight at carries called Pro Pectalin, which is kaolin pectin and probiotics, which is really nice for symptomatic treatment of kind of uncomplicated diarrhea. And I'm just assuming the OTC dog stuff doesn't have the salicylates, which are kind of like aspirin and it gets back into that angry guts. Having aspirin in them is not a good thing.

Mikel Delgado, PhD  50:46

Thank you. Can you speak to I think we've all heard about inducing vomiting at home. Do you have any thoughts on making a dog vomit if you're concerned about them eating something, I guess someone said mini carrots.

Dr. Tony Johnson  50:59

Oh, mini carrots are fine. But just because of the amount, I have to tell you a tale. So where I did my residency, they had a long standing policy of dog just ate, you know, my seizure meds, and we would give them instructions on how to make them throw up at home with hydrogen peroxide. So the people who own the dog were hairdressers, and they had the 30% industrial strength solution, not the 3% that we know. And the dog's esophagus basically evaporated and it did not end well. So there are certain conditions like if you are two hours away, I had somebody call once for consults and I told them to come in and they're like, I'm in Alaska in the middle of a weather storm, you know, so certain conditions where you can do it, it's best to do it with the guidance of a vet or a technician. It can be done definitely not in cats, cats’ esophagus is definitely too delicate for that. But you can do peroxide if you have no other options. You just got to make sure it's the 3%.

Mikel Delgado, PhD  51:54

What do you recommend for hypoglycemia until you can get to the vet.

Dr. Tony Johnson  51:59

Anything sweet. I had a kitten picture this, kittens a couple of weeks ago that were hypoglycemic. And we were out of dextrose like we were out of sugar for some reason. And we had just gotten breakfast for the staff and we had Cracker Barrel, those little adorable mini syrup things. So I'm like, Screw it, get me the Cracker Barrel, and we put it on the cat's gums until he came around and could start eating. But that's the first time I've ever used Cracker Barrel therapeutically. But yeah, Honey, don't do the fakie syrup, you'd want real actual sugar stuff. If they have an altered level of consciousness. You don't want to try and get them to eat it. You just want to slather it around their gums in their mouth. And hopefully they'll absorb it that way. And then if they do spring up, these are very satisfying the treatment clinic because you give some dexterous IV when it's not out of stock, and they just bounce up and they're like, where's the food, they're starving, and then you put groceries in front of them. And it's very, very rewarding.

Mikel Delgado, PhD  52:54

Nice. Okay, we are over time. But I did want to ask one last question, which is okay, someone's concerned about their pet, for whatever reason, should they call the emergency clinic first? Or should they get in the car and drive immediately?

Dr. Tony Johnson  53:08

It depends on the severity. I do think that call is always good, particularly nowadays, because we've had some times where we're diverting cases like we're not giving good patient care, because we're so overwhelmed or vet techs out with COVID. I had a doctor yesterday who was supposed to be receiving with me. She came in, she turned green, we sent her home. So I had to see all of this stuff myself. So it's a good idea. If you have time, that way, you know the wait time, you can talk about maybe a drop off appointment, the hospital, we'll have a heads up, you're coming. I mean, you can always call unless it's illegal to use a car phone in your state. You can always call on your mobile, and let them know and say I'm coming. So I think it's best to call if you can swing it.

Mikel Delgado, PhD  53:48

Okay, great. Well, this was amazing. I want to go to vet school. You can, I mean, I could, but

Dr. Tony Johnson  53:57

It's a tough profession. You know, literally most of my time is working for van and it's a cushy desk job. And I still do get into the ER to do it. But man two days and I'm drained. You know, doing it.

Mikel Delgado, PhD  54:09

I'm glad you're doing it.

Dr. Tony Johnson  54:10

This was fun and very enjoyable. I hope people got a lot out of it.

Mikel Delgado, PhD  54:12

Thank you so much.

Dr. Tony Johnson  54:14

Thank you guys. Are we all good? Any more questions?

Nicole Engelman  54:17

I think we're all set. But someone did comment that Cracker Barrel is therapeutic, which I agree with, and I just had to call that out.

Dr. Tony Johnson  54:24

You know, it's great. Yeah. I meant on my patients, on my patients. 

Nicole Engelman  54:30

So thank you all so much.

Dr. Tony Johnson  54:31

Can I just give one shout out for our client education website? Yes, it's called Veterinary Partner. And it's all stuff written by experts. You know, there's first aid stuff, their information on every disease under the sun and that one is powered by my employer and then the other good one is called petplace.com. I have nothing to do with it, but I found their information to be pretty good.

Nicole Engelman  54:52

Awesome. Well, I hope everyone got that down. And thank you again, Dr. Johnson for this. This was awesome. I think everyone learned so much. Myself included. And thank you to our audience for joining and asking such great questions.

Dr. Tony Johnson  55:04

Thank you. I'm signing off.

Nicole Engelman  55:06

So that wraps up this week's episode of The Good Dog pod. We hope you learned a lot from this episode. I know that I did. And we hope it'll be a helpful resource for you and your programs and most importantly, to keep your dog safe. Thank you again for tuning in to another episode and we'll see you right back here on May 15 for our next one. Thank you for listening to the Good Dog Pod. We'll be back in two weeks with another episode so be sure to subscribe to the Good Dog Pod on your favorite podcast platform.