Lessons from the ICU

Written by Dawn Crandell, DVM, DVSc, DACVECC

The ICU veterinarians, technicians and animal care attendants at the Toronto Animal Health Partners treat the hospital’s most seriously ill and injured patients.  Our work gives us unique insight into what medical problems are common, dangerous and preventable.  I’d love to share the inside knowledge we have with pet owners so they can take steps to keep their furry friends out of our ICU.  As much as our clients are grateful for our veterinary expertise, most would rather not have had to use our services.   Read on if you want some tips from those of us in the ICU trenches.

Know the signs of diabetes mellitus and don’t waste time if you are suspicious

We commonly see a condition called diabetic ketoacidosis (DKA), a life-threatening complication of diabetes.  Patients with diabetic ketoacidosis require several days of intensive, careful, medical care to survive.  Often a DKA crisis happens because the early warning signs of diabetes mellitus are not noticed, and the diabetic pet goes without insulin for days to weeks.  The pet owner hears the diagnosis of diabetes for the first time when they rush their pet to the hospital because it has collapsed into the vomiting, dehydrated, nearly comatose mess of the ketoacidotic crisis.  The early signs of diabetes that were missed are drinking more water than usual, urinating large volumes frequently and possibly unintentional weight loss.   If your pet has these early signs, collect a urine sample and see your vet right away, not in 3-4 days and certainly not next week.  The diagnosis of diabetes is easy; glucose is in the urine and the blood glucose is high.  Once diagnosed, its essential to get these patients started on insulin so they don’t spiral down into a crisis and end up in our ICU for a lengthy stay.

Know about these specific toxins

There are hundreds of toxic hazards pets could get into, and owners can’t know them all.  Most toxins cause illness but are not deadly, and many toxin exposures are thankfully rare.  Toxins that are both common and deadly include:

• antifreeze for dogs and cats
• lilies for cats
• xylitol for dogs
• rodenticides for both species

Take precautions to avoid all toxins, of course, but be especially aware of these ones.  A small amount of antifreeze will knock out kidney function irreparably within hours.  The antidote is increasingly difficult for veterinary hospitals to obtain, very pricey and must be given within minutes to hours to be effective.  We see antifreeze exposure when pets have access to newly opened cottages in the spring, when some of the sweet liquid has spilled on the ground in the garage, or if a jug has been left open and in reach of an inquisitive pet.  Lilies are also devastating to cat kidneys, and it only takes a nibble on a leaf to be life-threatening.  Check all bouquets for lilies before you accept them into your house. (Never underestimate a cat’s ability to seek out the toxic plant and chew on it!)  Rodenticide toxicity can cause catastrophic bleeding.  We have good treatment for rodenticide toxicity, but best to avoid the danger and expense by not allowing it into the house, and not allowing your pet to run free in new environments where a rodenticide may be set.   Xylitol is a sugar substitute that is popping up in many foods these days (peanut butter, ketchup, pudding, chewing gum, candies, medication additive).  It is safe for humans but can cause dangerously low blood sugar and then liver failure in dogs, even when small amounts are eaten.  Even with appropriate treatment, dogs have died from xylitol poisoning.  It carries no “dog danger” warning label on it to help owners avoid it.

Invest time and money in life-saving training for your dog

Forget “sit pretty” and “roll over”, put a priority on training your dog to do these 4 behaviours instead;

1. sit at the door rather than dash out
2. learn “leave it” to avoid eating anything he gets near his mouth
3. come back to you as soon as you call
4. have an automatic anytime, anywhere rapid “down” on command.

I have seen too many dogs smashed up by cars after they dashed out the door or across the street to catch a cat or squirrel or chase a scooter.  These could have been avoided if the doorway area was carefully managed so the dog never had a chance to dash out, or the dog was taught never to go out the door unless invited.  A strong “recall” (i.e. having your dog come when you call) will keep your dog safe from a multitude of dangers if he runs free on his walk.   Likewise, teaching your dog to lie down in an instant even if far from you can be life-saving if returning to you will mean crossing a busy road.   A solid “leave it” will prevent your dog from ingesting that disgusting chicken bone or dead mouse she might otherwise pick up on your walk, or from scarfing down the pill you just dropped on the floor.  Most owners need help to get any of these behaviours solidly trained.   Enlist a reputable, no-force dog trainer for a few private sessions (most are doing some remote sessions during the pandemic, so it is easy!).  The money and time you spend is a small investment in keeping your dog safe and is next to nothing compared to the heartbreak and financial toll of an ICU stay.

Get a lidded garbage can for your next barbeque

We have been seeing dogs who have sustained severe internal injuries from eating wooden barbeque skewers.   So tasty when covered with BBQ meat tidbits and juice, skewers are a dog’s dream chew-stick.  It’s no wonder they eagerly scavenge these from the ground, garbage or compost bins.  The dogs swallow the skewers whole or in big pieces, but the skewers do not get broken down by the intestine.  Instead, they puncture through the stomach or other part of the intestines and migrate through the dog’s body, causing pain and damage.  We have seen them track through the chest and cause a severe chest infection and an abscess near the shoulder or migrate through the abdomen causing life-threatening peritonitis.   Wooden skewers are almost impossible to see on a plain x-ray, so the diagnosis of the problem can be difficult and delayed.  Put used BBQ skewers directly into a garbage can with a lid that your dog can’t break into.  While you’re at it, throw your peach pits and corn cobs there too.  They are common items that are eagerly eaten by dogs but get stuck and need to be surgically removed.

Believe your vet if they say your pet needs to lose some weight

People take great delight in laughing at fat cat internet pictures.  You or your family might find the chubby feline look endearing and amusing, or wonder if your moment of fame lies in having your cat win the fattest feline contest.   Or perhaps your strategy is to denial; I have had clients assure me, in all seriousness, that the problem was simply the cat’s head was too small for its body.  However, ICU vets know that excessively overweight pets, particularly cats, are at high risk of death when they develop a problem that brings them to our care.  It is technically challenging to get an IV line into these pets; without IV access we can’t administer life-saving medications.  Obese patients have little space for their lungs to expand because their chest is full of fat.  With no extra capacity, even mild respiratory infections or problems knock them over like a feather.  Overweight cats who go a few days without eating develop hepatic lipidosis (fatty liver), a fatal condition unless treated with aggressive, weeks-long intensive care.  Anesthesia becomes a high-risk procedure in obese patients.   All serious medical conditions are harder to fight off when pets are morbidly obese, and the prognosis is worse than for pets of healthy weight with the same condition.   Consider significant excess weight a real medical problem and work with your veterinarian to help your dog or cat knock off those extra pounds.  It could save her life.