small white dog in 275/Hebron interchange  please call 859 586 2988
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A 1 year old male beagle was found wearing a light brown rope around his neck. Please contact us for additional details.

Twelve years ago, my daughter and I went searching for a new pet at the Boone Co. Animal Shelter. We looked over all the kittens and cats, and spotted the sweetest, most beautiful black, grey, and white striped tabby cat with the glowing gold eyes. He had been abandoned on a street in Florence. At that moment, he became the newest member of our family: Mikey. Over the years, Mikey has always been a very quiet and very loving member of our family.

Living alone, I recently became suddenly ill for several days. It seemed like a horrible situation to be in, but not so much. For that "special" striped kitty, Mikey remained at my side for four days, always stretching his long paws across me as I lay so ill in bed. If I moved, Mikey moved too, placing those paws by my face or across my chest. Mikey never meowed to be fed or to be let outdoors at that time.

The warmth of his furry body on my feverous skin gave me comfort I desperately needed. Oh, what a cat!

Mikey is my furry little angel of mercy.

Cathy Blackwood
Burlington, KY

Mikey visits Hebron Animal Hospital whenever he needs to go.

(Publication of this article is okay.)

Forwarded by a client:

This week I had the first case in history of raisin toxicity ever seen at MedVet. My patient was a 56-pound, 5 yr old male neutered lab mix that ate half a canister of raisins sometime between 7:30 AM and 4:30 PM on Tuesday. He started with vomiting, diarrhea and shaking about 1AM on Wednesday but the owner didn't call my emergency service until 7AM.

I had heard somewhere about raisins AND grapes causing acute Renal failure but hadn't seen any formal paper on the subject. We had her bring the dog in immediately. In the meantime, I called the ER service at MedVet, and the doctor there was like me - had heard something about it, but.... Anyway, we contacted the ASPCA National Animal Poison Control Center and they said to give I V fluids at 1 1/2 times maintenance and watch the kidney values for the next 48-72 hours.

The dog's BUN (blood urea nitrogen level) was already at 32 (normal less than 27) and creatinine! Over 5 ( 1.9 is the high end of normal). Both are monitors of kidney function in the bloodstream. We placed an IV catheter and started the fluids. Rechecked the renal values at 5 PM and the BUN was over 40 and creatinine over 7 with no urine production after a liter of fluids. At the point I felt the dog was in acute renal failure and sent him on to MedVet for a urinary catheter to monitor urine output overnight as well as overnight care.

He started vomiting again overnight at MedVet and his renal values have continued to increase daily. He produced urine when given lasix as a diuretic. He was on 3 different anti-vomiting medications and they still couldn't control his vomiting. Today his urine output decreased again, his BUN was over 120, his creatinine was at 10, his phosphorus was very elevated and his blood pressure, which had been staying around 150, skyrocketed to 220.. He continued to vomit and the owners elected to Euthanize.

This is a very sad case - great dog, great owners who had no idea raisins could be a toxin. Please alert everyone you know who has a dog of this very serious risk. Poison control said as few as 7 raisins or grapes could be toxic. Many people I know give their dogs grapes or raisins as treats including our ex-handler's. Any exposure should give rise to immediate concern.

Onions, garlic, chocolate, cocoa, and macadamia nuts can be fatal, too.

You are very welcome. 

We hear all too many times about someone we know whose pet went under anesthesia for a routine procedure and never woke up.  I want you to know the cases in our area that I am aware of have all been from human error and archaic anesthetics, and zero monitoring technology.  i know of a dalmation puppy that passed from a spay about 4 years ago from another hospital.  this kind of substandard care gives a bad image of all veterinarians.  I resent that.  The Hebron Animal Hospital has over $30,000 invested in anesthetic monitoring equipment to head off these scenarios, the very best and safest anesthetic agents, a combined 53 years of experience in its doctors, and a commitment and discipline that has made anesthesia for pets every bit as safe as that administered to humans.  I don't know of ANY other animal hospital in the tri-state with this kind of investment in equipment.
We have successfully performed anesthesia on animals in their 20's (yes, years of age), pets with heart failure, kidney failure, liver failure, diabetes, hypertension, you name it.  I am very confident in our abilities.  I hope my discussion is taken in the context intended: we're dedicated, serious, well invested, and determined to provide the absolute safest anesthesia possible.

Dr. Lloyd

Clearly what I am to discuss here this evening is hardly a question to a vet, since I'm providing the answer for that not asked.  But I would like to attempt a discussion and dissemination of what I believe to be some very important information.

Many of you have heard of an ingredient in most of today's sugar free gums called xylitol.  It is safe, it reduces bacterial counts of the mouth, and it is beneficial to diabetics...for HUMANS that is!  It's popularity has grown to the point that people are now baking with it.  However it is very slow to get out to the general public that this ingredient is deadly poisonous to dogs.  Let me explain:

Xylitol is poisonous to dogs, but almost indirectly.  It isn't a poison in and of itself, but rather it acts as a massive dose of sugar to a dog's system, triggering a massive release of natural insulin.  Of course xylitol is more an alcohol than a sugar, but either way, it is NOT sugar.  So this massive dose of insulin does it's thing and drives blood glucose into the cells of the body, dropping the blood sugar precipitously.  Anyone that has heard of or witnessed "insulin shock" knows how deadly this can be.  The symptoms start with ataxia, or a drunken gait/walk, progress to seizures, and then a coma ensues.  If a dog survives this part, liver failure may set in within the next week or so and cause the pet's demise.

So why am I bringing this up?  Well it happened to my own dog, Lenox.  Lenox is not your average dog.  She is a 95 lb female Bernese Mountain Dog, and has severe separation anxiety issues.  The night of her intoxication we had left to eat out at a local restaurant at 7PM.  We returned at 8:15PM.  I let the dogs out for a walk upon my return, and my wife came outside within a couple of minutes yelling that "the stupid dog" got on the table again and ate my 16 year old daughter's pack of gum.  She asked if that was going to hurt the dog.  I told her only if it has xylitol in it.  A few minutes later they came outside with a shred of the gum package, and sure enough, it had xylitol in it.  So I got on the Internet real quick just to determine how toxic it was and what was the lethal dose.  I hit a few veterinary password protected websites for some in depth information and speed read everything I could find.  I ran upstairs and got the hydrogen peroxide bottle and started pouring it down her throat until she vomitted.  this was about 8:35PM.  She brought up a lot of wrappers, some gum, and a strong "grape" smell.  I decided to watch her close to see how things would or would not progress.  By 9:30PM Lenox was staggering and walking like she was drunk and could not navigate stairs that she normally takes 3 and 4 at a time.  Melinda, my wife, and I raced her down to the clinic.  Her blood sugar was still 89...not dangerous.  I wanted to keep an eye on her, so we grabbed every supply we might need to treat her at home if she deteriorated.  By 5:30 AM she couldn't walk, but she was very depressed, stuporous, but her blood sugar was only 83.  So I brought her to work with me and we treated her with IV fluids, intravenous steroids (helps the patient to be more insulin resistant and helps bring the blood sugar up and it also helps stabilize cell membranes), and intravenous dextrose (sugar).  She was much improved 36 hours later and came home, still a bit wobbly.  It was probably 3 or 4 more days before her recovery seemed 100%.

Conclusions I have drawn:  The symptoms and side effects of this toxicity are clearly not just from the massive insulin release as Lenox had neurologic symptoms far more serious than would be expected with a blood glucose of 83.  Clearlly the xylitol is toxic to the neurologic system.  What is unknown:  1)  Lenox was on Metronidazole, an antibiotic used for the treatment of diarrhea.  In an overdose situation this antibiotic is known to have neurologic side effects.  Alcohols can often increase the absorption of many substances in the gastrointestinal tract.  Could xylitol have increased the expected absorption rate of the metronidazole and caused some of the extreme side effects?  2)  Lenox has been on Clomipramine twice a day for 3 years for the control and treatment of severe separation anxiety (the reason she got the gum off the middle of the dining room table right after we left the house in the first place).  This drug also has effects on the neurologic system and we don't believe any overdose symptoms would mimic what Lenox experienced, but we also don't know how clomipramine and xylitol might interact with each other.  My belief is the xylitol, consumed very shortly after she was given the metronidazole, increased the absorption of the metronidazole and likely caused a lot of her neuologic symptoms.  If this is not the case, then it is my belief that the xylitol is far more poisonous than at first we (as veterinarians) believed.

To summarize:  Xylitol IS poisonous to dogs.  It causes a precipitous decrease in blood sugar and can lead to ataxia, seizures, coma, liver failure, and death.  The lethal dose to a dog is ONE STICK OF XYLITOL SWEETENED GUM PER 14 LBS OF BODY WEIGHT!!!  Lenox ate 15 sticks of gum, or about 2.5 times the lethal dose.

I hope this sheds some light on a subject most of the readers here have never heard about, but I felt you need know as we go into the Holiday season and many of you may have artificially sweetened goodies around the house.

Sincerely,

Dr. Lloyd

Thank you for your prompt reply.

I am very confident with your knowledge and procedures.  I especially like the way you emphasize the need for monitoring. 

I doubt that anything can be said or done to remove totally my minor anxiety regarding general anesthesia.  However, your comments do offer reassurance and help keep my concerns to an appropriate level.

Hopefully, other readers can benefit from these posts.

Without going into a lot of detail, the anesthetic protocol we currently use is far more advanced than that described above.  From the injectables to the gas anesthetics we are lightyears ahead of 98% of the animal hospitals in the world.  Of critical importance isn't necessarily the drugs, but the anesthetic monitoring equipment that monitors every measureable vital statistic of the patient,  with necessary alarms to draw attention to a change in trends WELL before a pet gets into trouble.  We just don't have anesthetic "events".  Measureable vitals include % oxygenation of the blood, heartrate, EKG, capnography, respiratory rate, core body temperature, and indirect blood pressure measurement.
I and the doctors at Hebron Animal Hospital are very familiar with all the specific needs of all breeds.  I agree with Dr. Smith about all the drugs she states to avoid.  However her anesthetic protocols do not adequately address pain management, which we are very cognizant of and adamant that we control pain.  Dr. Smith also does not address the benefits of laser assisted surgery. 
I'm glad there are vets out there that take the time to address issues and advise/educate pet owners.  I personally know multiple veterinarians that are using quite archaic anesthesia at other hospitals, of course.  Mastiffs are hardy enough they would rarely suffer any ill fates or dire consequences from this "archaic" anesthesia, but it is not near as safe as that which we provide.  We have anesthetized numerous Mastiffs for everything from C-sections to complex orthopedics to routine spays/neuters.  By routine we're referring to the surgical procedure, NOT the anesthetic episode.

I hope this answers your concerns,

Dr. Lloyd

My Mastiff is going to have surgery soon that will require general anesthesia.  I recently found this article on the subject and wanted to present it to Dr. Lloyd for his information and opinion.

A little OT..... Thanks for providing the "cyber tools".  I appreciate your efforts.

Anesthesia and the Mastiff
By Robin M. Smith, DVM

I thought that I would talk about anesthesia concerns and the mastiff since that is the most frequently asked question I get from mastiff owners.

First off, you MUST have a veterinarian that is willing to listen to you and who is not afraid to be questioned about their anesthesia methods and how they monitor the pet once they are under anesthesia. If they do not want to discuss this or if they have a comment like, "well, I have always done it so and so way and I am not going to change", find yourself another veterinarian. I think that the public needs to be aware of exactly what is happening to their dogs and the risks that are possible. ALL anesthesias are putting the dog at risk... BUT there are some that are much safer than others and I will discuss these.

To start, I want to mention a few anesthesias that I would avoid if at all possible. In the past, most of these drugs were used exclusively, but with the advent of the new drugs and safer ones, they should not be used in the mastiff. Mastiffs are not just big chihauhas. The mastiff generally has a slower heart rate than smaller dogs and they also have inherently a lower blood pressure. They also, as you know, have a larger body mass. These things add to the risk of anesthetizing them.

I never use acepromazine anymore as a pre-anesthetic or tranquilizer. Acepromazine lowers blood pressure and dilates blood vessels thereby making the blood pressure even lower. It also is metabolized (gotten rid of by the body) very slowly and tends to accumulate in fatty tissues. Therefore, larger dogs and fatter dogs usually have to be given a larger dose than normal in order to have effect, and because of this, it takes these dogs sometimes days to get back to normal. I have used it a lot in the past... In fact, it was the "gold standard" for pre- anesthetic sedation, but not anymore. Many people have used it in tablet form for tranquilization during stressful periods, i.e. thunderstorms. Again, I used to use it for this, but do not now, especially in giant breeds... It is too unpredictable. Just to let you know, I use Benadryl for thunderstorms at a dose of 1 mg./lb but not to exceed 100 mg. and find it works very well to make the dog tired and rest better.

Xylazine (Rompun) is another drug I avoid. I haven't used it in about 5 years. It makes the heart more susceptible to the effects of epinephrine (adrenalin) that is in the body and therefore, making the dog more susceptible to heart abnormalities. It is a difficult drug to dose in giant breed dogs.

Acepromazine and Xylazine are the two drugs that I try to avoid if possible. If your veterinarian is also a large animal (cow, not mastiff) veterinarian, he may very well use the two drugs as they are used in farm animals a lot.

If for some reason, your veterinarian must use these two drugs, I think it is mandatory that the dog be monitored by an EKG machine during surgery and immediately post-operatively.

Other drugs that I do not use much although they are still used are the thiopentals. These are like sodium pentathol. They work very rapidly to knock the dog down, but are very powerful and stay in the system a long time. Also if the drug gets out of the vein (like if the dogs jump) the thiopentals can irritate the surrounding area and completely slough the area (all the tissue dies).

The drug(s) that I use the most in mastiffs are valium, ketamine, telazol, and propofol.

A combination of valium and ketamine given intravenously will be enough to knock the dog down in order to insert the endotracheal tube. Both of these drugs are very safe and I use them a lot in the older dogs. Neither one effect the heart much.

Telazol is very similar to valium and ketamine and also works well for anesthesia so that an endotracheal tube be place (I use .1 cc/lb and do not exceed 1.5 cc total).

I do use propofol (deprivan) for short procedures, i.e. OFA radiographs. Propofol is a fairly new drug in the veterinary field but has been used for a long time in the human field. It is a milky solution that after opening a vial cannot be stored. It gets contaminated with bacteria very easily. Because it is expensive, the veterinarian may try to cut corners and use old leftover propofol that is sitting in the fridge. It is given to effect or in other words, it is given IV until the dog goes down and then the dog is intubated and put on gas. The GREAT thing about this drug is that as soon as the animal is taken off the gas, the dog is awake and can walk out without assistance. I have also used the drug in C-sections to sedate the dog long enough to insert the endotracheal tube. It is a very top of the line drug. I do find the dosages of propofol to be a lot lower than the manufacturers literature dosage. One added thing: Propofol can lower blood pressure so the pet needs to be monitored while on that.

I also use oxymorphone for sedation and sometimes as the sole sedative for simple procedures like biopsy. It is an opiod and therefore it can cause respiratory depression, which means that the dog needs to be constantly monitored. There is a reversal agent called Naloxone that will reverse the effects of the drug and works quite well.

I will always put the dog on gas for a fairly short procedure. Isoforane is a gas of choice since it has fewer side effects. Halothane is still being used by some veterinarians. I do not use it since it (just like xylazine) sensitizes the heart which can cause irregular beats. But, as long as the dog is properly monitored, there should be no problem.

Prior to ANY anesthesia in any aged animal, I require a pre-anesthetic blood work up. I get a PCV (monitors whether anemic or dehydrated), a BUN (monitors liver and kidney function), Creatinine (monitors kidney function), ALT (monitors liver function), Alkaline phosphates (monitors liver and the biliary system), Total protein (monitors the immune system and hydration status), glucose and the electrolytes (sodium, potassium and chloride). I get these as I said even in young animals... It is just good medicine to know where the dog is prior to surgery and anesthesia so we will know how they will tolerate anesthesia. It is the base line. These test also guide me to my use of anesthesia. For example, if there is kidney damage I know to avoid drugs that have to go through the kidney to be eliminated from the body. The temperature is also monitored along with the heart by an EKG.

Atrophine was a drug that was used all the time as a pre-medication to dry up the saliva in dogs and cats and to keep the heart rate up. It is not used much anymore, or shouldn't be used in large and giant breeds. I don't use it in any breed anymore. Atrophine causes the gut to slow down and this is not good especially in the mastiff. I believe slowing the gut down predisposes the mastiff to bloating.

Anesthetic Protocols:

   1. Routine spay or neuter. I hate the word ROUTINE used here because no surgery is routine. I used valium at .3 mg/kg and ketamine at 10 mg/kg IV and then I put the tube down the trachea and start the dog on isoforane gas anesthetic. I have not had problems with these in the mastiff.
   2. OFA radiographs. I know many of you try to get OFA radiographs while the animal is awake. An unsedated animal is very hard to position correctly, but even more importantly OFA asks you to sedate the dogs. OFA believes that by not sedating the dogs, we're not getting good representative x-rays. I believe if the OFA radiographs are done with sedation, it would be very hard to miss a dysplastic animal. Depending on if the dog is going to go right home or stay in the hospital. I will use 2 anesthetics for each case. If the dog is staying, I use the valium/ketamine mixture and if the dog is not staying, then I use the propofol and then the dog is intubated. Just another added note. I always put an IV catheter in for a quick access to the blood stream in case something does happen and I need to give drugs quickly.
   3. Cesearean Sections. The main goal here is to obtain the least sedation possible in the puppies. For the Ceaserain section, I utilize Propofol at a dose of 3 mg./ lb. or until I can get an endotracheal tube down the dog. If I had to choose a second choice I would give the bitch torbutrol and valium as a preanesthetic as described next and then intubate after masking down. I use torbugesic at .45 mg/kg and give it to the muscle. Then I give valium (.45 mg/kg) intramuscularly. We prep the bitch on the floor by shaving her belly and then when done, we put her on the table and mask her down. We put a large mask over her muzzle and turn the gas all the way until she is alseep enough to put the endotracheal tube in. While masking the bitch down, she may struggle since the dog thinks it is not getting oxygen, even though it is. The trick here is to get in and the puppies out ASAP. Propofol can also be used and I have had good results with it. The bitch is wide awake as soon as the last staple is in. I am comfortable with either one.

Those are probably the three most common surgeries I do on mastiffs. Don't let the anesthesia scare you. Where there is some risk has been lowered by doing all the blood work and the pre-op exams that I mentioned above.

If you have any questions regarding anesthesia or just anything, please feel free to contact me.

            Robin M. Smith, DVM
            Westminster Veterinary Emergency/Trauma Center
            269 W. Main St., Westminster, MD 21557
            Work 410-848-3363
            (Fax) 410-848-4959
            E-mail: RocknRob56@aol.com

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