Visiting Veterinarian : Even on Martha's Vineyard, dogs eat things they shouldn't
Young dogs are notorious for eating the inedible, and Portuguese Water Dogs (PWDs) seem particularly prone to this indiscretion. That's not just me saying so. The ASPCA Animal Poison Control statistics indicate significantly more calls about PWDs than predicted based on the breed's overall popularity. So I wasn't surprised when I got an after-hours call about Ruby, a young PWD who had eaten — okay, don't get grossed out, these things happen — a tampon.
"My daughter thinks she left two unopened on the table," the owner reported. "I just found Ruby chewing an empty plastic applicator, and only one on the table."
The decision about how to handle nontoxic foreign body ingestion rests largely on the question of what poses greater risk — making the dog vomit the item, or hoping it will pass out the other end. Ruby was medium-sized so there was a reasonable chance she could pass a typical feminine hygiene product, but we had to consider the material might swell significantly as it absorbed stomach juice, and the string might have difficulty winding its way through the gastrointestinal tract
"Regular or super?" I asked delicately.
"Super," mom replied.
"You should induce vomiting at home," I concluded. Regurgitating the soft material was unlikely to cause a problem. If we got it out of her stomach, she'd be all set. I advised feeding bread or bulky food first. This would help expel the tampon, carrying it up like a little raft riding the wave on a sea of food.
"Now give a tablespoon of hydrogen peroxide mixed in milk," I continued. Peroxide irritates the stomach, usually making dogs upchuck. Milk simplifies administration because dogs foolish enough to eat tampons won't hesitate to lap up bowls of peroxide-laced milk.
Fifteen minutes later, Ruby had not barfed. "Give another tablespoon of peroxide," I advised. "But if that doesn't work, don't give any more. Too much peroxide can cause severe gastric inflammation."
Another 15 minutes elapsed. No barf. The owners now had a choice. Wait and see if Ruby eventually pooped out the tampon, knowing that, if it got stuck, she might need surgery, or an emergency visit now to induce vomiting pharmacologically. They opted for the latter.
When Ruby arrived, I instilled a tiny dose of apomorphine into the conjunctiva of her eye. Absorbed quickly through these membranes, apomorphine acts directly on the brain, sending a message to puke.
Fifteen minutes later, nada. More apomorphine. Finally Ruby vomited — a lot. I fished through pile after pile. (Being a veterinarian is so romantic.) Food. Corn husks. More food. Paper towels. No tampon.
"Looks like she got into trash," I declared. "Maybe she just grabbed an empty applicator out of the garbage and there's no tampon in her tummy after all?" A tampon wouldn't show up on X-ray. Ruby had emptied her stomach thoroughly. There wasn't anything else to do right now. "Observe her carefully," I instructed. "Check her feces. Give this lubricant laxative. If there really is a tampon in there, this will help move it along."
As I mopped the floor, the phone rang again. A miniature poodle named Rembrandt had eaten a pack of sugar-free, xylitol-sweetened gum. In people, xylitol is absorbed slowly into the body without provoking significant insulin release, but dogs absorb xylitol extremely quickly, leading to a huge surge of insulin production by the pancreas. This is a big problem because insulin doesn't recognize xylitol as regular sugar (glucose.) Instead it does its job of moving any available glucose out of the blood into the cells. As a result, the dog's blood sugar plummets, causing a profound, life-threatening hypoglycemia. At higher doses, xylitol also causes fatal liver failure in dogs.
Little Rembrandt had eaten a potentially deadly amount. I again advised feeding bulky food and inducing vomiting at home immediately with peroxide. "Then come right in," I said urgently. "This is a serious emergency."
On arrival, Rembrandt's owner presented me with newspaper-wrapped vomit, containing slimy bread, but no gum. "I'm on the phone with Animal Poison Control," I said, then informed the toxicologist that Rembrandt had vomited but not expelled any gum.
"Give apomorphine anyway," she advised. "It's more effective for completely emptying the gut."
Rembrandt happily ate cat food as I instilled apomorphine in his eye. Within minutes, I was again poking piles of puke. Ah! Multiple pieces of multicolored gum — Megamystery-flavor Stride, to be exact. But Remy had eaten 12 pieces and only vomited six. There was still enough in his system to be possibly problematic. Hypoglycemia can occur as rapidly as half an hour after ingestion, but also may be delayed as long as 12 hours. We weren't out of the woods.
"On the mainland, an emergency clinic could monitor his blood sugar overnight," I yawned. "But there's no 24-hour clinic here and the last ferry left hours ago." I have on rare occasion had clients charter the Patriot to go off-Island late at night, but Rembrandt's blood sugar was fine so far and he looked stable. His owners could do the night shift nursing at home and wake me if needed.
"Watch him closely," I cautioned. "Feed him every two hours to keep his blood sugar up." If Remy developed signs of hypoglycemia, such as staggering, weakness, or vomiting, they should rub Karo syrup on his gums and call me back pronto. I sent them home with medications to protect his liver and instructions to return first thing in the morning. "If his blood sugar is still normal then, we can stop worrying about hypoglycemia. But have your regular veterinarian watch his liver enzymes over the next two days."
I mopped the floor. Again. It was after midnight. If I got to sleep soon, I might get six hours of shut-eye, I thought wearily. As long as Rembrandt's blood sugar didn't nosedive in the wee hours, or some other pooch didn't eat an inedible late night snack, or some other catastrophe didn't befall another dog or cat or — Zzzzzzzzzzzzzzzzzzzz.