Did you know that the dwarfs in the original Grimm’s version of “Snow White” were nameless? In 1912, they were dubbed Blick, Flick, Glick, Plick, Snick, Whick, and Quee for a Broadway production, and ultimately received their familiar Disney monikers for the 1937 film. What does this have to do with veterinary medicine? Well, I felt a bit like Disney’s Snow White last week. No, little birds and forest creatures were decidedly not helping me clean house, nor was I whistlin’ while I worked. In fact, ol’ Doc was kind of Grumpy when a family arrived at my office with a sick dog … without an appointment.
Now I understand. Your pet is ill. You’re worried. You want to rush right to your veterinarian. But except for specialized emergency hospitals, most veterinarians work by appointment. Not because we are uncaring — because it just makes sense. For one thing, at many practices there is not always a veterinarian physically in the clinic. It doesn’t help your dog if you arrive at my doorstep while I’m on a house call in Aquinnah. Even if I’m onsite, we always appreciate a heads-up that an urgent case is en route. But here were these folks, and a dog that was staggering and falling over. Heigh-ho, heigh-ho, it’s off to work I go.
The dog’s behavior was clearly altered. She would lie down, motionless, flat as a pancake, eyes staring blankly. When roused, she could stand and walk, but would sway, stumble, then lie back down. Her gums were nice and pink, so probably not internal bleeding. Temperature, slightly below normal. Heart rate, steady but on the slow side. Looking at her eyes, the pupils were slightly dilated, but responded normally to light. No abnormal movements like those associated with balance disorders such as canine vestibular syndrome. No other neurological signs, like uneven pupils or head tilt. All her limbs worked; no paralysis. Probably not a stroke or brain tumor. No vomiting or diarrhea, as often seen with food poisoning. I had a strong suspicion what the diagnosis was. The dog was Dopey.
Marijuana toxicity (from oral ingestion) is not uncommon in dogs. Clinical signs can include incoordination, listlessness, stupor, dilated pupils, slow heart rate, and occasionally vomiting, red eyes, low blood pressure, low body temperature, and/or urinary incontinence. Symptoms usually develop within a few hours of ingestion, and last anywhere from half an hour to four days. If we catch it early, we induce vomiting, but often once signs appear, it’s too late to bother. Luckily, marijuana toxicity is rarely dangerous. If Dopey had seizures or became comatose, hospitalization and aggressive treatment would be needed, but as long as she was rousable, conservative home care was likely sufficient. We syringe-fed activated charcoal to minimize further absorption of any drug still in her gastrointestinal tract, and gave fluids to support blood pressure and hydration. I thought the owners might be Bashful about the pup getting into the pot, but they assured me they had a medical marijuana card. Dopey went home with instructions to keep her warm and safe, and make sure every hour she was able to wake up and stand.
Sneezy was next. This fierce elderly Chihuahua has the unenviable combination of bad heart and bad teeth, but she isn’t very cooperative about letting me examine her mouth. Her mother managed to pull up her lip for me to get a peek. The gum over the large upper fang was receding much higher than it should, with nasty chunks of dental calculi adhered to the tooth. At that moment, Sneezy started sneezing, spraying gobs of green … well … snot, all over the table, and all over me. The revenge of the little dog! Without anesthetizing her to explore further, I couldn’t prove it, but I suspected she had an oronasal fistula — a tract that runs along the root of the upper canine tooth and opens into the nasal cavity, leading to inflammation of the nasal passage. Definitive treatment often requires surgery. If Sneezy were younger, we might send her first to a cardiologist, then a veterinary dentist for dental x-rays to determine whether extraction of the tooth was necessary. Then Sneezy would have her teeth cleaned with carefully monitored anesthesia tailored precisely to her cardiac disease, and the oronasal fistula would be surgically repaired. Unfortunately, Sneezy’s advanced age and heart problem makes this all risky. Instead, we prescribed antibiotics to treat the infection.
Finally came a big, goofy, dog with a sore on the end of her very long tail. When this cheerful pup got wagging, she would bang the tip and it would bleed. The owner was worried the sore might be cancerous. “Nah,” I said, smiling. “It’s Happy Tail!” That’s what we call it when a dog repeatedly traumatizes its tail by vigorously whacking it against stuff and is just too happy to care. Treatment? Protect the end of the tail. I showed the owner how to put a simple padded bandage on Happy’s tail that she can reapply regularly until the wound heals. Sometimes simple bandaging is not enough. Being a creative bunch, veterinarians have come up with a multitude of unique solutions. A plastic syringe case, cut and padded, makes a perfect hard, cylindrical tube to cover the tail tip. Pipe insulation or those foam pool noodles (slit open longitudinally) work well for larger dogs, and can be secured around the end portion of the tail. Some docs tape the tail down to the hind leg, but that seems an awkward solution to me. Occasionally none of these mechanical barriers work, and the only solution is to amputate a portion, as a shorter tail is less likely to whip around and hit things.
Can I wrap this up with a “happily ever after?” Well, by the next day, Dopey was almost back to normal. Sneezy soon stopped sneezing on the antibiotics — a temporary fix, but one we can repeat as needed. Happy’s tail is healing. The End. I’m Sleepy now. Heigh-ho!