Tuesday, August 7, 2012

For the Love of Mango! (or How I Learned To Loathe Rope Toys)

by Dr. Karel Carnohan

I arrived in Manhattan, Kansas in an RV filled with four dogs, seven cats, a house rabbit and a parrot – excited about starting my new life as a vet student.  My dogs included Flash ,4 year old shepherd mix who had been abused as a puppy, Parker, an 11 year old Golden Retriever who I rescued from a life of neglect, Dougie a 5 year old Chihuahua-pug mix, and Molly, an 8 year old pug.

Parker, the Golden, was a sweet, gentle, wonderful dog who, during my sophomore year in vet school, died after surgery to remove a hemangiosarcoma in his abdomen.

To honor Parker’s memory, I rescued a one-year-old female Golden from the Topeka Humane Society. 

Mango
There were several Goldens at the Shelter and I decided to adopt this girl because she had a bad rap sheet.

Her previous owners was a couple with a young baby. They  surrendered the dog because she “chewed through $350 worth of pillows and household items and crapped all over the floor”.  Oh my, sounded much like a normal Golden puppy to me but with that record who would adopt her?

I filled out the paperwork and warned the staff that the only reason I would return the dog was if she was an intractable chaser of rabbits or cats; she would have to adjust to life with the Carnohan tribe.  

I drove her home and she marched into the house, flopped down on the kitchen floor and calmly let the cats and the rabbit check her out. She was going to be just fine.  After treating her gastroenteritis causing the runs, never giving her the chance to chew the pillows by crate training her and giving her chew toys, Mango became a well-behaved member of the family. 

I had always been a cat person and my dog experience was relatively new – pretty much the result of working at an emergency clinic preparing for vet school. Flash, Parker, Dougie and Molly were never destructive chewers and my collection of Kongs, rope toys, stuffed animals and a various assortment of rawhide chews seemed to be safely enjoyed by my pooches.  Then along came Mango.

Mango was a chewer.

She loved going at her toys with unabashed vigor; I was pleased she destroyed her toys and not the couch cushions, although one or two bit the dust. She quickly killed the stuffed squeaky toys. I bought new ones and within five minutes each one was dead. I had the common sense at that point to get rid of the plushies but I didn’t suspect that the rope toys would cause any trouble – they were hard as rocks and indestructible. Little did I know.


As freshmen vet students, there were no classes Friday afternoon and you were encouraged to don your freshman scrub top, identifying you as a rank beginner, and spend the afternoon in the clinic observing, learning and getting your first look at what to expect in three years.  Not being as young as some of my classmates who liked to blow off steam on Friday afternoons in Aggieville, I didn’t miss a Friday in the clinic. I loved it.  I loved watching surgeries.

My favorite professor was a wonderful man, a top-notch surgeon, named Dr. Dennis Olsen. He was a marvelous teacher and whenever he was behind the glass in a surgery and would see me, he would wave me in so I could observe first-hand. I would don the hair net, the mask, the booties and the gown and watch this man perform what I could only think of as miracles for hours every Friday. I learned so much from Dr. Olsen and had the utmost respect for his passion for teaching.

One day, Mango began vomiting and stopped eating.  

After multiple bouts of her vomiting and me seeing a young dog not looking very happy, I took her into the clinic.  The clinicians, along with the 4th year students,, worked her up.

Radiographs were taken and it showed something in her stomach…. a gnarly, amorphous blob filling it up. 

I made every attempt to learn as I fretted about my dog’s fate and readily agreed that Dr. Moore, our expert with the endoscope, should attempt to pull out whatever was in Mango’s stomach, saving her from surgery. It was worth a shot.

Mango was anesthetized and wheeled into the scope room where Dr. Moore began to guide an endoscope probe with a prong at the end into Mango’s throat. 

This prong looked like one of those tools to grab light bulbs too high to change by hand, only smaller and stainless steel.  The room was filled with technicians, students, interns and residents.  We were all intently watching the TV screen as the probe travelled down Mango’s esophagus. Everyone was taking bets (no money involved – vet students are poor) as to what exactly the blob in Mango’s stomach was: a dishtowel had top votes, a sock, underwear (Oh, I really hoped it wasn’t that), a stuffed toy…..just what?

Dr. Moore arrived at the stomach and we all looked at the screen and saw a jumbled mass of …… no one could really tell. 

There was some grass, we could see that.  Dr. Moore grabbed the blob , made sure she had a good grip, and began to gently pull, trying to guide the mass through the opening of the stomach and up the esophagus.  She was having a difficult time; it wouldn’t budge.  She tried re-gripping and pulling from different angles but no luck.  Finally, she announced that the scope wasn’t going to work and started to remove the probe. Only, the probe wouldn’t come out…. it was stuck!  She kept trying but she could not get the probe out.

A quick call to surgery….. get a surgical team ready to go and a suite ready….Mango was going directly to surgery!

Now, through all this, Dr. Moore is telling everyone how expensive that probe is, thousands of dollars, and that it needed to be protected from any damage. I am sweating bullets worried about Mango and now, the probe. It wouldn’t be a good start to my career to be the student whose dog destroyed an expensive endoscope probe.

So here I am, handed the end of said expensive probe sticking out of Mango’s mouth, now free of the endoscope, as the dog is wheeled through the clinic halls towards surgical prep, closely followed by Dr. Moore (continually exhorting me to be careful with the probe) and about a dozen students and doctors.

All eyes were on this entourage and I am dying, just dying.

As Mango is being prepped for surgery, who comes out of the scrub room but Dr. Olsen.  If  I hadn’t had both hands gripping the probe and he hadn’t been scrubbed and sterile, I would have given him a big bear hug.  His kind eyes looked at me from behind his mask , and then he looked at the dog, then at me again and said “You’re assisting me, right?”  My stress and fear disappeared and I replied “Of course”.

The entourage was still a buzzing mass outside the surgical suite looking in through the glass windows.  Dr. Olson calmly instructed a technician to take over holding the probe as I gowned up.  The first order of business was to open the stomach and carefully disentangle the probe’s fingers and gingerly hand it back to Dr. Moore.  Whew, at least that was done.  Now, we could focus on saving Mango.

Dr. Olsen began to explore the blob in Mango’s stomach, now exposed.  

He gently moved it and revealed a large, mass of cotton string intertwined with a great amount of grass.  Mango had tried to resolve her stomach ache by eating grass. The grass had mixed with……. oh it dawned on me….it was the rope toy.

However, it didn’t look like the nice tight rope I remembered; it had expanded into a Medusa-like chaotic mess.  

As Dr. Olsen explored further, he discovered that this mass of string continued its tangled chaos through the pyloris and into the small intestine.  He couldn’t pull the mass out because it might do a lot of damage to Mango’s intestine.  This is what is called a “linear foreign body” and it is very dangerous because it has the potential of doing a great deal of damage to the intestines which are continually contracting to try and move its contents along.  Dr. Olsen ran the intestine (carefully examining the length of the intestine in a disciplined orderly way) and determined that this linear foreign body was potentially quite long.  He made the first incision in the small intestine a few inches below the pyloris and cut the “rope” to remove part of it. He proceeded to make eight more incisions before he announced that Mango’s gut was free of her rope toy.

With 9 incisions and a stomach to close, it took another hour to finish the surgery. We were exhausted.

Mango made a full recovery and I purged my house of rope toys, rawhides and plushies, restricting Mango to large Nylabones , Kongs and beef knuckle bones.

She went to surgery one more time a while later. 

We were visiting my sister, who had small dogs with small toys, and I didn’t  think to pick them up before it was too late. But Mango lived another 11 years, healthy, happy and never again needed to go to surgery until last Summer when we discovered she had a mass in her abdomen. However this time it wasn’t her fault; it was cancer and she passed having lived a great life.

I learned my lesson the hard way about dog products and warn my clients about dangerous toys.  


Each client knows his dog best and some dogs are fine with rope toys and plushies and never shred them. However, if they shred at all, consider the risk and think of Mango and me with the endoscope wheeling down the clinic hall. 

My vet school experience with Mango also went a long way to forge my knowledge about handling abdominal symptoms.

If I had waited much longer, Mango could have died.

It is important not to wait long before taking your dog or cat to the vet when he shows signs of something wrong; vomiting, especially vomiting with nothing coming up, is a sign of several serious and life-threatening conditions including bloat and foreign bodies.

I have seen the sad result of clients who wait when the veterinarian suggests an exploratory abdominal surgery, only to have their beloved pet die.  

Veterinarians’ diagnoses are limited to the information they have and radiographs and ultrasounds can only tell them so much.  We were taught in school never to be afraid to suggest exploratory surgery, if the patient can handle it.

Most of the time, surgery gives the surgeon a clear view of the problem and it gives him/her the option to take biopsies. 

It sometimes exposes other problems that were not obvious.

With blood work and exams, a veterinarian can determine how safe it is to perform surgery and carefully weigh the risks involved.

It is often safer to do surgery than to “wait and see what happens”.   

I had a client who brought in her dog on emergency for vomiting , lethargy and inappetence.  The exam, radiographs and the blood work didn’t tell us anything but the owner suspected a foreign body.  I suggested an exploratory even though we really didn’t know what was going on. I explained my reasoning and the client agreed.

We opened the dog up to find massive ulcers in his stomach.  

Not only did we get an immediate answer, we were able to take biopsies, check the rest of his abdomen, and best of all, we were able to directly place six to ten sulcralfate pills into the stomach (a medication that coats the stomach and goes a long way to help ulcers to heal).  We sent the dog home on antacids and he made a full recovery.

The owner was very happy she made the decision. So was I.

***

Dr. Karel Carnohan graduated from Kansas State College of Veterinary Medicine in 2005 having returned to school after working 20 years in corporate finance.

After practicing in private practice for six years, she founded Animal Nutrition & Wellness Services in 2011. Often not having the time for in-depth discussions with her clients about nutrition and managing the home environments for their animals, Dr. Karel decided to focus her work on helping clients manage their pets’ nutrition and wellness environments. 


Her training at K-State included extensive education and practice in food safety and nutrition. Dr. Karel is a member of the American Association of Veterinary Nutritionists and is passionate about tailoring her clients’ pets’ nutrition as part of an overall wellness program that includes home environment, special medical needs, and client preference.  Care & recommendations are fully independent of ties to commercial pet product companies and are based on well-researched and proven evidence.

Dr. Karel lives in Vancouver, British Columbia with her numerous rescue animals – dogs, cats and Woody the parrot. She enjoys returning to a hair-decorated home after a game of hockey or a spin in her kayak.

http://animalnutritionandwellness.com
Dr_Karel on Twitter.

8 comments

  1. Thanks for the heads up - our dogs are chewers and they prefer harder items. So we stopped giving them raw hide chews. It's funny that when you start writing about dogs you learn how many things aren't great for our dogs.

    Our dogs are great with rope toys, but like with all their toys, they play with them under supervision. This is how we've learned which toys they can handle (not destroy and eat) and which they can't. They just play tug of war with the rope toys.

    When you have multiple dogs, it's so important to really identify which toys are okay and which aren't, because your attention is divided between multiple animals.

    I can't tell you how much I appreciate this story.

    Kimberly

    ReplyDelete
    Replies
    1. That is definitely true, the more one gets into writing and reading about dogs, the more they realize that there is danger lurking everywhere. Sometimes I miss ignorance... :-)

      Supervision is so important, and with multiple dogs even more so. Jasmine has always been good with this stuff - only ate a sock once and it was by accident (she was trying to hide it in her mouth until it went down. Fortunately she threw it up shortly after; that's when we found out she actually swallowed it.

      JD, on the other had, will eat whatever he can fit in his mouth. Sadly, he can even eat kongs for breakfast. So no toy is really safe with him.

      Delete
  2. We have a "supervised only" policy with rope toys in my house. Elka used to just kind of bop around with them, play tug, gnaw on them frozen when she was teething, that kind of thing. Then she got older, and realized it was a great deal of fun to just chew them apart. To my knowledge, she only pulls them apart, never ingests any of it, but better safe than sorry!

    ReplyDelete
    Replies
    1. Definitely, always better safe than sorry. Some things that can happen are just plain wild.

      Delete
  3. Thanks for the heads up. Our dog has a history of chewing things up too, but luckily it's mostly been paper products like tissues. We haven't ever done a rope toy but had been thinking of doing one for a while. Now that I've heard your story we probably will stay away from them!

    ReplyDelete
    Replies
    1. I think using such toys to play with your dog is fine as long as the dog is being supervised. It is when nobody is watching when the trouble happens.

      Delete
  4. Oh, my. We've been there, except Sage managed to throw up the piece of plastic toy she ingested. Even so, she vomited and vomited and vomited until we took her to the emergency vet (of course it was a Sunday night). Fortunately, no surgery and all was well after a little dehydration treatment. Lesson learned? No more plastic toys!!

    ReplyDelete
    Replies
    1. You never know what ends up on a dog's stomach. Glad it came out on its own, even though at the price of some dehydration.

      I think most toys are safe when used under supervision; finding safe toys for dogs to have while alone is a trick, though.

      Delete

MINIMAL BLOGGER TEMPLATES BY pipdig