Visiting Vet: Beach tummy

Surgery wasn’t needed!

A dog playing fetch on a beach may ingest too much sand. —Nimity Keon

“What a sweet face,” I thought as Havilah, a 2-year-old golden retriever, bounded into my office. Havi’s family had been here on vacation for a while, but were heading back to the Midwest by car in just a few days. Truly embracing Vineyard life, they had spent much of the previous day on the beach playing fetch with their dog, throwing the ball into the water or down the stretch of sand. Since cooler fall weather had arrived, heat stroke was not a big concern, especially in a fit youngster like Havilah, and a fine time was had by all.

That evening, however, Havi began acting distressed — pacing, crying, and whimpering. At one in the morning, her owners took her outside. She passed a little urine. At three, she had a small bowel movement. All night long the poor girl was clearly uncomfortable, and when the sun came up, so did Havilah’s dinner. Her owners called right away for an urgent-care appointment.

“Hello, sweetheart,” I said as we lifted her onto the exam table and I offered a small treat. With any vomiting patient, we typically withhold food and water until their system settles down, but this delicious liver treat was a diagnostic tool. Did Havi feel well enough to accept a tasty morsel? Of course, we always take a dog’s breed into consideration. A Labrador will eat a snack with three paws in the grave, while a perfectly healthy Pomeranian might turn up his nose at filet mignon. But I digress. Havi considered my tiny tidbit, then slowly decided to eat it.

I checked her color — her gums were nice and pink, though a tad dry and tacky. A healthy, well-hydrated dog should have moist, glistening gums. Her facial expression seemed mildly concerned, but not distressed. Temperature, normal. Heart and lungs, normal. Abdomen, her belly was soft and pliable, and she did not tense or exhibit any pain on palpation.

But wait. Hmmm. What was that? An area in her mid-ventral abdomen felt a little odd. Nothing I could identify definitively, just kind of … doughy. My final step was a rectal exam. Nothing other than a little residual feces that appeared normal.

Time to talk more with Havilah’s owners. I went outside and sat on the porch to chat. First question. Was there any possibility that the dog had been in any body of water containing blue-green algae? Toxic algae blooms are happening here more and more these days, thanks to climate change, and even small exposures can be lethal to dogs. But, no, Havi had only been in the ocean. Second question. Could she have eaten anything on the beach like dead crabs, fish, jellyfish? No, she had been on a lead all the time, or closely observed. Third question. Was she a dog who tended to eat inedible objects? Many young dogs have a proclivity for ingesting everything from socks to rocks. The answer to the third question was, Maybe. A few months back, Havi had eaten a ribbon, which upset her tummy but eventually passed in her stool.

“Considering all this, I think we have two main things on our differential diagnosis list,” I said. “She probably ingested either a lot of saltwater, sand, or both, while playing fetch.” Saltwater ingestion can lead to a condition called hypernatremia — a fancy word meaning high sodium in the blood. Excessive sodium disrupts an animal’s electrolyte and fluid balance, and depending on the severity, can cause anything from increased thirst with vomiting and diarrhea, to seizures, coma, and death. Dogs can develop hypernatremia as a result of many diseases, or by eating salty things. Although I have seen occasional cases related to drinking seawater, most cases of hypernatremia in dogs come from binge-eating things extremely high in salt, like homemade play dough. Diagnosis is a simple blood test measuring sodium levels. The mainstay of treatment is intravenous fluid therapy to lower the sodium levels, but fatalities do occur.

Sand ingestion actually topped my list. Forty years ago I saw another golden retriever who presented with vomiting. Radiographs revealed a baseball-size rock in the dog’s stomach. Since it was late afternoon, we scheduled surgery for the following day. When the dog returned the next morning, I took another film to check if the rock had moved further down the gastrointestinal tract before beginning surgery to remove it. To my surprise, no rock. Instead there were lumps of sand coursing throughout his intestines. What had appeared to be a big, solid rock had actually been a dense wad of sand, and it was moving down and out of the dog all on its own. Cancel that surgery!

We admitted Havilah for diagnostics, and determined that although her sodium levels were normal, she did, indeed, have three big, sausage-like tubes of sand in her small intestines. That was the doughy area I had felt in her belly. The tubes were large and dense enough I was concerned they might require surgical removal, but remembering that other golden with the sand “rock,” I knew it made sense to try medical treatment first to see if it would pass naturally. We gave Havi fluids to hydrate her, injections to reduce inflammation, pain, and nausea, and a whopping serving of feline hairball medication (which is basically flavored, medical-grade petroleum jelly) to work as a lubricant. She went home with instructions to repeat the lubricant every eight hours, eat baby food slurry watered down to a soup, walk frequently, and have her stools observed. “If she isn’t better tomorrow, she needs further treatment and possibly surgery,” I cautioned them. “You may have to delay your travel plans.”

Early the next morning, I got a very happy email. Havilah had passed multiple stools made completely of sand, and was already feeling much better. The family could head home as planned. “Thank you so much,” the owners wrote. “We’ve never been so glad to see our dog make poo sand castles.”