Beware the Chinese Chicken

True story.

No, a drumstick will not make your brain stop tickin'. However, over the last year the FDA has reported a rather dramatic increase in reports of pet illness that may be related to chicken jerky treats made in China. Concerns are now extending to duck and sweet potato products. Problems have ranged from vomiting and diarrhea to kidney failure and death; however, I should emphasize that no direct link or cause has been identified yet, and nothing has been recalled as of yet. In other words - don't panic.

On the other hand, there have been more than enough reports to warrant avoiding Chinese-made jerky treats and tossing any you may have bought, just to be on the safe side. Frankly, China has jack for safety regulations, a fact underscored by several recalls of very dangerous products produced there in recent years.  I try to avoid anything with "Made in China" on the back, period. Sorry, Beijing.

This is also a good opportunity to point out two great resources for information about pet food and product recalls. The American Veterinary Medical Association maintains two recall lists, one for foods and another for pet products:

• Pet Food Safety Recalls and Alerts (AVMA) 
• Pet Product Safety Recalls and Alerts (AVMA)

Of note, several brands of thyroid medication were also recently recalled. Manufacturing issues may have led to non-uniform pills (that is, varying drug strengths); this probably won't cause serious side effects, but if your dog is on thyroid meds you should ring your vet's office to see if you've received any of the problem lots. Also, some Petco food bowls were recalled due to radioactivity. I couldn't make this stuff up.

Out Of The Kitchen And Into The ER: Four Dangerous Foods For Pets

Folks often ask me if this-or-that food is okay for pets. I like to tell them all people foods are "toxic" to animals, since even moderate quantities can lead to a chronic condition proven to shorten lifespans and known colloquially as FAT, or Food-Amplified Tissue syndrome. You can read more about that in this article. Furthermore, anyone whose Lab has ever raided the trash can can tell you that enough of anything a pet isn't used to eating can result in a few days of sickness (and maybe a visit from the carpet cleaners). Of course, some things in the kitchen can harm your pet much more quickly and severely, and today's article covers the four biggest culprits.

Lets start with a few general notes. First off, if you are concerned about something Muffy indiscriminately scarfed down the first thing to do is call your vet. If they aren't open, try the nearest pet emergency hospital or Animal Poison Control. They can tell you if you should freak out, how much you should freak out, and what you should do next (after they get you to stop freaking out). The risk is usually going to depend on how much toxin went into how much dog; that is, a nibble of onion or milk chocolate probably won't faze a Great Dane, but it could be enough to kill your 2-pound chihuahua. Cats also tend to be more sensitive to most toxins, food or otherwise.

Anyone else suddenly craving Italian?

Onions and Garlic
Plants in these families contain sulfur compounds that can damage red blood cells, causing them to rupture. Since red blood cells are responsible for carrying oxygen to the body's cells, and those cells need oxygen, this is kind of bad. Common signs logically include weakness and pale gums; however, these problems occur hours to days after exposure. Note that garlic and onion powders are just as dangerous, and may be used in processed human foods in significant portions - just one more reason to keep pets out of the people food!

Grapes and Raisins
These can trash your pet's kidneys. Kidneys are rather important. Raisins are more potent in this regard, which shouldn't be surprising since they are basically grapes minus the water - and water, at least, is good for kidneys.

Before anyone asks -yes, some dogs and cats seem to tolerate grapes and raisins just fine, and we aren't sure exactly what the mechanism for the toxicity is in the first place. On the other hand, some pets die from eating these. Just keep them out of them, okay?


Chocolate

Fortunately, there is nothing wrong with
eating chocolate in front of your pet.
Which I think I shall now do.

Cocoa contains stimulants that are very dangerous for pets. Early signs include vomiting and diarrhea, leading to extreme excitement and agitation (imagine your chihuahua on three cups of espresso), and even death.

But wait - a culinary lesson! Chocolate is a blend of sugar, fats, and cocoa; the amount of these determines the type, flavor, and quality of the chocolate. Milk chocolate has little actual cocoa, dark has a good bit, and semi-sweet or baker's chocolate is mostly cocoa. This is important because the more cocoa, the more danger for your pet. White chocolate is made with cocoa butter rather than actual cocoa powder, and so is fairly harmless unless they try to eat their weight. How much is too much? Check out this excellent interactive chart from National Geographic. But remember, each dog is different - contact your vet if you are worried!


Xylitol (that's a sweetener, not a Russian side dish)
This is present in many sugar-free gums, mints, vitamins and even toothpaste. Within 30 minutes of ingestion it may cause a dog's blood sugar to drop to dangerous levels, resulting in seizures, coma, or death. Worse yet, even if they don't show these signs some dogs may develop liver failure hours to days later. Because of this overnight hospitalization and monitoring is advisable in most cases.

Lastly, this list is not exhaustive. These are the most common and dangerous food items; other things like macadamia nuts, avocados, and fruit seeds may be harmful as well. APC has a nice question-and-answer list covering the good, bad, and mostly-harmless foods folks often ask about. But definately keep Muffy out of  your stash of sugar-free, chocolate covered raisins dusted in onion powder! You can send me some, though. That sounds tasty.

Anesthesia - Keeping The Big Sleep Safe

Few things make owners as nervous as anesthesia. Heck, when I was first unleashed upon the world as "Dr. Rowland" anesthesia wracked my nerves way more than surgery. I distinctly remember the first time I knocked a patient out - I calculated the dose, double-checked it, then looked it up and checked it again, then read the drug monogram for the Nth time and checked the dose several more times. I've gotten over that, of course. Wouldn't see many patients at that rate!

Here's the thing - with the right drugs, good monitoring, and a relatively healthy patient anesthesia is quite safe. But anesthesia is never without risk, and should never be taken lightly. Today's article is geared toward relieving the anxiety most of us feel when our pets need to be anesthetized - by giving you knowledge about what the risks really are, and what we (vets and owners) can do to minimize them.

Monitoring
Guess what the best way to miss a problem is? Not looking for it.

A fully-functional veterinary monitor.

Anesthetic drugs don't just cause loss of consciousness - they may affect heart rate, blood pressure, respiration and more. In case you don't know, these things are kind of important. The body has needs - nutrients, oxygen, and removal of waste products produced by using those things. Respiration and circulation are how the body gets it done. So it only makes sense to closely monitor how all that's working, right? And since a living body is a pretty complicated bugger, there are many things that can go wrong and many things we can watch to recognize problems and address them before they get out of hand. Here's what I consider minimum monitoring for most procedures:

• Heart rate and blood pressure - These are the main determinants of blood flow, but they can also clue us in on "depth" of anesthesia and even other problems like blood loss.
• Electrocardiogram (ECG) - That's the green wave with the reassuring beep on the TV hospital shows. The heart is a complicated pump running on electricity; an ECG looks at that electricity to identify problems with rate, rhythm, or coordination of the heart.
• Respiratory rate and blood oxygenation - Blood flow to your pet's tissues does little good if it doesn't have oxygen. And, even if you are breathing, lung or circulation problems can keep the body from getting the oxygen it needs.

Except for pulse and respiration, all those require special equipment to monitor. But this belies an important question - who monitors the monitors? Indeed, the most important monitor of all is the human being keeping track of, interpreting, and responding to all this information. Since the veterinarian is usually kind of busy -cutting this, stitching up that, and keeping sterile all the while - the best monitor is a living, breathing, highly-trained veterinary technician. They keep an eye on all that data for problems, address the minor stuff, and let me know when I need to stop playing with this or that organ and focus on what the rest of the patient is doing. Plus they monitor important stuff no machine can, like reflexes and gum color, and administer whatever treatment the vet deems necessary if problems do arise. 

How Do I Know You're Healthy?

A 2008 British study showed that anesthetic risk increased almost 7 times for patients with significant systemic disease. That's not exactly surprising, but I'd go farther and say the most common reason for anesthetic problems in patients we think are healthy is that they aren't healthy. Pets with early or mild disease often compensate well and show no outward problems - until we knock them out with a bunch of drugs that reduce their ability to compensate. Here's what I recommend before any anesthetic procedure, to feel reasonably comfortable your pet is healthy:

Occasionally, bloodwork is really surprising.
This pet appears to be possessed by demons.
(okay, not really...)

• A Good History & Physical Exam - The importance of these can't be overstated. Changes in appetite, activity level, urination or other behaviors are major clues to systemic problems. Likewise, many problems with the heart and lungs can be heard with a stethoscope. Some diseases leave early signs that can be seen with a good look at the eyes, skin, or mouth. And more than once I've felt something that shouldn't be there in the abdomen of an outwardly normal patient.
• Basic Bloodwork - Simple blood tests can identify problems with the liver or kidneys that may not cause clinical problems in your pet - until we challenge them with a bunch of anesthetic drugs. A blood count can also catch problems like anemia or inflammation, which in turn may be clues to undiagnosed infections or immune diseases.

Realistically, even if we ran thousands of dollars worth of MRI's and fancy bloodwork we couldn't be 100% sure your pet didn't have some strange, subtle disease. But those simple things will rule out the majority of problems without breaking the bank - a simple blood panel runs about $40-$60 most places. 

Anesthetic Drugs

The drugs used for anesthesia are really your vet's prerogative, and far beyond the scope of this article. However, it's worth briefly mentioning two things about drug choices. First off, when we do find a health issue with a pet that requires anesthesia we use that knowledge to select the safest anesthetic drugs for the condition. Each drug has it's own profile of side-effects that may impact the heart, liver, kidneys, etc; none are without side effects, but we can choose those least likely to aggravate the patient's individual problems.

Secondly, pain and stress also impact many of the things we worry about during anesthesia - heart rate, blood pressure, and even the heart's electrical rhythm. While I haven't came across any studies establishing that good pain control leads to safer anesthesia, it stands to reason that a less stressed, pain-free patient should handle anesthesia better. Most of us nowadays provide sedation prior to inducing anesthesia and various kinds of pain relief (analgesia) during procedures for just this reason.

What Should You Do With This Knowledge?

Here's the point - understanding all this means you can make informed choices when your pet needs anesthesia. Here are some questions you should now be able to ask when choosing a vet for a procedure:

• What kind of things do you monitor when Muffy's asleep?
• Is there a person watching Muffy while he's out? What kind of training do they have?
• What kind of bloodwork do you recommend? 
• Based on your exam, do you think Muffy's okay for anesthesia? Is there anything else we should check?
• If the procedure may be painful, what kind of pain control do you provide?
• Do you have any other questions about Muffy, Doc? (That is a smart owner question.)

So, why tell you all this? Thing is, many great, smart veterinarians don't do all the things they'd like to or feel they should because of financial reasons - that is, you won't pay for it. Not every clinic provides all these services, and many clinics that do offer everything mentioned above make them "optional" for an additional fee. Those monitors I talked about run $3,000-$10,000, with a life expectancy of a few years. The technician monitoring the monitors is $13-25 per hour. If you won't pay for it, we can't pay for it - or we have to cut costs somewhere else, which isn't good for your pet either. Honestly, I don't put the blame for that on pet owners, but squarely on we vets - we can't expect you to pay more if you don't understand why the extra money is worthwhile. Hopefully now you do, and can make informed decisions about who treats your pet and how. The most expensive place in town may not necessarily be the best, but I can pretty much guarantee if you price-shop around for the cheapest place your pet is missing out on some or all of these safety measures. 

Likewise, some vets make good arguments that some of the things discussed here aren't necessary. And maybe they aren't strictly necessary - the vast majority of outwardly health animals are indeed healthy, and would probably be fine if knocked out with a 20-year old drug protocol and ignored. Bear that in mind if you truly can't afford the extra money for all the "best" care. But most of us can handle an extra $100-150 for good monitoring, pain control, and some basic bloodwork; the peace of mind it buys is worth a lot more, if you ask me.