A:“Back problems” in Dachshunds can be more accurately described as “spinal problems.” While the most common site for a Dachshund to develop a spinal problem is in the back or thoracolumbar spine, they can also suffer from problems in the neck, or cervical spine. To clarify further, when we talk about spinal problems in Dachshunds, we are almost always talking about issues associated with Intervertebral Disc Disease. This is a condition in which an intervertebral disc is protruding to some degree, or completely prolapsing, causing some level of compression of the spinal cord, and resulting in pain and/or neurologic dysfunction. Dachshunds are frequently associated with this disease and are likely more susceptible to it than any other breed.

The single best thing that you, as a Dachshund owner, can do to prevent problems associated with this disease is to control your dog’s activity. Ideally, every Dachshund should avoid high-impact activities, especially jumping, high-speed running, and any activity that will put excessive force on the spine. Some of the common activities that many Dachshunds take part in every day and ideally should avoid include:

1. Jumping up onto or down off the bed, couch, chair, car seat, etc.;
2. Going up and down steps, even at slow speeds! Standard stair cases are not well-suited proportionally to Dachshunds. Going up and down steps for them would be like a person climbing steps that are as tall as they are!;
3. Running at top speed to chase a squirrel, ball, dog, car, etc.;
4. Rough-housing with other pets or humans;
5. Tug-of-war (BIG NO-NO!)

The following are a number of “devices” that can help them avoid these type of activities. While they may seem overly simple or obvious, and you may already be using them, our doctors are certain that there are countless Dachshunds in the world today that are routinely not using these items:

1. Leash – Ideally coupled with device #2;
2. Harness collar – This is a device that in our opinion, no Dachshund should live without. This is a collar that fits around the dog’s whole upper body and helps distribute the force of the leash over a larger surface area rather than having all the pressure applied to the neck, as would happen with a traditional neck collar. This will certainly protect the dog’s neck and, if they are an aggressive leash puller, may also help prevent some of the twisting and turning motions that can happen along the rest of the spine when pulling hard at the end of a leash attached to a traditional neck collar. The leash and harness collar should actually be considered as a single device that should always be used together, and which every self-respecting, health-conscious Dachshund should demand from their caretaker.;
3. Dog crate – This is the single most effective way to prevent all the aforementioned high-risk activities that can happen when you are not home. Many dog owners are very resistant to this idea because they feel they are essentially punishing their pet by keeping them cooped up in a crate. When implemented properly, however, it can actually be a comforting sanctuary for them. Make it big, make it comfortable, feed them and give them treats in it; and you may find that they are quite happy to spend the day relaxing in it while you are out. Alternatively, keep your Dachshund confined to a room with no furniture on which they could jump.;
4. Ramp(s) – These can be bought or constructed and strategically placed throughout your home. Dogs can be trained to use the ramp instead of jumping up and down off furniture or using some stairs.;
5. Your own two hands – If a ramp is too impractical, pick your dog up to place them up and put them down from any place that they would otherwise have to jump. Carry them up and down steps rather than have them do it themselves. Ideally, Dachshunds should be trained to stay off furniture.
6. Measuring cup – This should to be used to measure the amount of food you are feeding your dog. Obesity is one of the most common health issues facing our domestic pets today and, good news, it’s avoidable! It has also been identified as an increased risk factor for Interverterbal Disc Disease. Every Dachshund owner (and every dog and cat owner for that matter) should ask their family veterinarian to give them guidelines on how much to feed their pet to maintain a healthy body weight. As the pet parent, you are empowered to enforce the recommended diet.

Some of these suggestions may seem either overly simplistic (i.e. leash), or even a little extreme (i.e. crating your dog every minute your are not home), but they are the same practical suggestions our doctors have made to the caretakers of dozens of Dachshunds suffering from Intervertebral Disc Disease treated on an emergency basis. Lucky for some Dachshunds, their disease was mild and they were able to benefit from these suggestions before facing the prospect of surgery. Others, after expensive surgery and sometimes a paralyzed pet, wish someone had told them sooner.

George Motley, VMD Emergency Department Supervisor

Melissa Logan, PhD, DVM, DACVIM (Neurology)

• Put us in your contact list, (609) 259-8300, so you can call us on your way
• If your pet has not been to our facility before, stay one step ahead of the game and fill out a new client form now, before an emergency occurs
• Keep your pet’s documents, records, medical or vaccine history in a secure and easily accessible location
• Make sure you have a safe and secure carrier for each pet with your name and contact information on the carriers. This applies especially to cats; cats can get spooked a lot easier than dogs on their way to the vet
• Place your pet’s leash or harness including tags/identification in a convenient location; preferably by the front door
• Make sure you have a fresh supply of all your pet’s medication; checking the expiration dates regularly

In case of evacuation due to a natural disaster, etc., here are some additional ways to help prepare you and your pet for the unexpected.

• Keep us in your contact list, (609) 259-8300
• Make an emergency survival kit; this may include bandages, isopropyl alcohol, hydrogen peroxide, etc. Discuss with your family veterinarian what you may need in your emergency survival kit
• Make sure you have basic necessities such as food and water, litter and trash bags to dispose fecal matter and a pet safe cleaner
• If your pet has a microchip, make sure you have the identification number with your pet’s documentation; be sure to keep all documentation/medical records in a water resistant bag
• Take and keep a photo of your pet just in case your pet gets lost or separated from your family
• Make sure there are emergency boarding facilities in your area for your pet or a pet friendly hotel/motel outside the danger zone
• Hang a pet emergency sticker outside your home to notify rescue authorities how many pets live there. Please do not abandon your pet(s) unless your life is in danger!

This blog was written by one of our veterinary technicians, Tamara. To learn more about the 24/7 emergency service offered at NorthStar VETS, visit www.northstarvets.com

Why physical rehabilitation?

The benefits of physical rehabilitation are numerous! Decreasing pain and inflammation, improving mobility and joint range of motion and helping regain muscular strength and endurance are just a few of the benefits.

Initial treatment

Postoperative physical therapy begins immediately after surgery. Cryotherapy, the use of ice applied to the surgery site is of tremendous benefit in decreasing swelling and pain. Icing can continue every 6 hours for 3-5 days, once a pet is taken home after surgery.

Passive Range of Motion and Massage: Both of these techniques, which are easy to perform, are also started shortly after surgery. Passive range of motion helps to maintain joint movement in pets who are not yet using their limbs as they should be. Massage feels good to us and feels good for our pets. It is very helpful in improving local blood flow and decreasing muscle tension, which is common after surgery.

Leash walking: In pets that have had orthopedic or neurologic surgery, a crucial part of rehabilitation is beginning slow leash walking. The key word here is SLOW! Teaching pets to walk slowly often “forces” a pet to use the affected leg even when they do not want to. It also helps to “retrain” animals to walk after neurologic surgery.

Progression of Rehabilitation

Approximately 2 weeks after surgery, we begin formal rehab. At NorthStar VETS, we meet with clients and patients to assess the pets’ pain level, recovery and formulate a plan of home exercises. These exercises may include more intensive walks, stretching, weight shifting exercises and beginning some strength training with tools such as physio rolls, cavelettis, wobble boards, etc. At this time, we will also begin underwater treadmill therapy. The underwater treadmill is extremely beneficial, especially in early recovery, because the pet is buoyant in the water which reduces the strain on the affected limbs or limbs.

It is hard to say how long a physical rehabilitation program may take because each pet is an individual. However, we do know that pets heal faster and get back to better function sooner with rehabilitation therapy. Finding a certified rehabilitation professional is the first step. They will work with you to develop a program to meet the needs of you and your pet, and help you to get them on their feet as fast as possible.

For more information on rehabilitative therapy, visit the rehabilitation page at www.northstarvets.com or call us at 609.259.8300.

Pamela Levin, DVM, CVA, CCRT
Dr. Levin earned her Bachelor of Science degree in Animal Science from the University of New Hampshire in 1992. She graduated from Ross University, School of Veterinary Medicine in 1998 after completing her senior clinical rotations at Oklahoma State University. Dr. Levin has practiced as a small animal general practitioner and emergency and critical care veterinarian in New York, New Jersey, California, and Massachusetts. Pam has served as Director of Emergency Medicine at a small animal referral and emergency hospital in Massachusetts. Dr. Levin received her Certification in Veterinary Acupuncture in 2009 through The International Veterinary Acupuncture Society and her Certification in Canine Rehabilitation Therapy in 2011 through the Canine Rehabilitation Institute. Prior to joining NorthStar VETS in 2011, Dr. Levin served as staff acupuncturist at a small animal referral and emergency hospital in New Jersey. Dr. Levin’s areas of interest include improving patient’s quality of life though pain management, therapeutic exercise, and noninvasive alternative therapies. She is a member of the American Veterinary Medical Association, New Jersey Veterinary Medical Association, American Academy of Veterinary Acupuncture, International Veterinary Acupuncture Society, American Association of Rehabilitation Veterinarians, and the International Veterinary Academy of Pain Management.

Denisse, a lovely 12 year old girl in a 3 year battle with Osteosarcoma, has a dream of becoming a veterinarian. NorthStar VETS’ team turned a typical Saturday for them into a very special day for an exceptional young lady.

We began in Dentistry with Dr. Lewis and he had Lancelot, the cougar, already sedated and underway with his tooth extractions. His being here was an awesome bonus to her visit today! Having undergone many medical procedures and surgeries of her own, Denisse had no problem getting up close and personal with Lance as Dr. Lewis continued to work on his mouth. When I told her prior about the possibility of blood she said it was no problem at all. She listened to his heart with the stethoscope, viewed his extracted teeth and learned as Dr. Lewis explained his problems. Touching his paw and being so close to a big cat like this was a once in a lifetime opportunity for her. She took it all in and loved every minute of it. (See the video on the NorthStar VETS YouTube channel.)

On from Dentistry we headed to surgery, CT and MRI where Dan B. went over scans including those of a chinchilla, turtle, parrot and even a liver shunt CT angiogram. Again a seasoned patient in her own right, she let us know she would be having a CT within the next couple of weeks. That CT would precede what would be her 28th surgery. Denisse has Osteosarcoma and has been battling the cancer courageously for 3 years. Her concern throughout today was if the animals have any pain. She has to deal with it always. It seemed important to her to know that the cougar would not experience any pain when he went home. I assured her he will be made comfortable. She said pain is not good. I agreed.

We continued onto the nursing wards where she had some hands-on time with employee pets (Jillian’s and Deon’s). Though tentative with the big dogs, she gingerly held a Yorkie when encouraged by Dan B.

Heading over to Exotics she saw a gecko, rabbit and conure. Onto an African Grey exam with Dr. Doolen and Stephen, then to PT where Jillian explained the underwater treadmill while a patient did his laps. She was thrilled but at this point very tired. We knew it was time to end and though she was excited to see more she just couldn’t go on. Denisse explained a low blood count was making her feel this way. (See Denisse and Jillian at the aqua treadmill on the NorthStar VETS YouTube channel.)

Being on a 10 day break from chemo, Denisse was able to have enough strength to come to NorthStar VETS. We were blessed to have her. We let her know she is welcome back at anytime. She hopes she may get the chance to do so again in the future. In February, she goes for that 28th surgery, so keep her in your thoughts and prayers.

For information on the Ashley Lauren Foundation, visit www.ashleylaurenfoundation.org

The mission of The Ashley Lauren Foundation is to bring hope and help to children in New Jersey who have been diagnosed with cancer.

Their goal is to ease the journey when pediatric cancer is diagnosed by:

• Providing resources for financial and material assistance as well as emotional support so the journey is never without hope
• Connecting with community, friends, and family so the journey is never alone
• Ensuring that young adults ages 18-21 are provided the same services afforded the youngest patient so the journey is a bridge to the future
• Forming a link with centers of care so the journey is never without direction

Eileen Schuck

Marketing Assistant at NorthStar VETS

Director of Vet-i-Care

• Underwater treadmill
• Therapeutic laser therapy
• Therapeutic ultrasound
• Neuromuscular electrostimulation (NMES)
• Manual therapies (massage, stretching, joint and soft tissue mobilization)
• Therapeutic exercise for improving range of motion, strength and balance
• Acupuncture and electroacupcunture
• Pain management including medications and supplements where appropriate

Pets suffer from many of the same ailments as people

In the human world, you would never consider NOT having physical therapy after an orthopedic surgery! The same is becoming true for our canine friends, many of whom who have sustained the same injuries and had the same surgeries that we have. Rehabilitation is known to speed recovery, improve mobility and help to restore function. The same is true for our pets.

Rehabilitation for older pets
Rehabilitation is not just for patients recovering from surgery or injuries. We cannot forget about our older pets. Just as we can experience arthritis, so too can our pets. This is a very painful condition that can really affect quality of life. We may think that our pets are “just slowing down” but this is often a sign of pain. Using a combination of therapies, we are often able to make a big difference in our senior pets lives by helping to improve their mobility and lessen their pain, allowing them to live out the “golden years” as best as they can.

What about laser therapy?

Therapeutic laser is another non invasive therapy used to help with pain. Laser uses a beam of laser light to deeply penetrate tissues without damaging them. Laser energy induces a biological response in the cells which can decrease pain, reduce inflammation and speed healing. It is commonly used for arthritis, strains, wounds and other dermatologic conditions. It is simple and painless to apply and is oftentimes used in combination with other modalities to enhance its effects.

The role of acupuncture in rehabilitative therapy

Last but not least, what about Acupuncture? This ancient Chinese modality has been successful in treating a variety of ailments in both humans and animals. It is not invasive, not painful and can be very beneficial in controlling pain, improving energy level and improving quality of life. Most animals are able to relax and come to enjoy this therapy.

All of us want our pets to be happy, healthy and pain free. There are many ways that we can accomplish these goals. Dr. LoScrudato and Dr. Pamela Levin at NorthStar VETS will do a comprehensive exam and review medical history to come up with a plan that best meets the goals and needs of each client and patient. Our patients love to see us because they know we are making them feel better!

For more information on rehabilitative therapy, visit the rehabilitation page at www.northstarvets.com or call us at 609.259.8300.

Pamela Levin, DVM, CVA, CCRT
Dr. Levin earned her Bachelor of Science degree in Animal Science from the University of New Hampshire in 1992. She graduated from Ross University, School of Veterinary Medicine in 1998 after completing her senior clinical rotations at Oklahoma State University. Dr. Levin has practiced as a small animal general practitioner and emergency and critical care veterinarian in New York, New Jersey, California, and Massachusetts. Pam has served as Director of Emergency Medicine at a small animal referral and emergency hospital in Massachusetts. Dr. Levin received her Certification in Veterinary Acupuncture in 2009 through The International Veterinary Acupuncture Society and her Certification in Canine Rehabilitation Therapy in 2011 through the Canine Rehabilitation Institute. Prior to joining NorthStar VETS in 2011, Dr. Levin served as staff acupuncturist at a small animal referral and emergency hospital in New Jersey. Dr. Levin’s areas of interest include improving patient’s quality of life though pain management, therapeutic exercise, and noninvasive alternative therapies. She is a member of the American Veterinary Medical Association, New Jersey Veterinary Medical Association, American Academy of Veterinary Acupuncture, International Veterinary Acupuncture Society, American Association of Rehabilitation Veterinarians, and the International Veterinary Academy of Pain Management.

Goals of Rehabilitative Therapy

• Maintain or restore joint range of motion
• Improve muscular strength and coordination
• Decreasing swelling
• Manage pain
• Promote healing
• Improve weight bearing and prevent compensatory gaits
• Prevent repetitive injuries in sporting dogs
• Improve mobility in senior and arthritic pets
• Weight loss in obese pets

Rehabilitative Techniques

Physical rehabilitation is hands-on work. Using techniques such as massage (yes, pets love it as much as we do), mobilization of soft tissues and joints, and targeted therapeutic exercises, we are able to accomplish these goals. We incorporate lots of equipment that you have seen at your gym or physical therapy office, such as exercise balls and bands, stairs, water treadmills, ramps and electro-stimualtion units. In addition, we commonly incorporate therapeutic laser which is a very useful modality that when applied to affected areas, can increase blood flow, decrease inflammation and improve cellular energy.

How pet owners can help rehabilitate their animals

Animals cannot rehabilitate themselves, so owner participation is a big part of what we do. All of our owners receive “homework” or exercises that we would like them to perform at home. Exercises are progressed over time as the animal becomes stronger. We also must be prepared to treat compensatory problems. Often, when a pet has been lame or painful for a long time, they change their body mechanics in an attempt to take the weight off the affected area or part of the body. As a result, other parts of the body can become affected. Rehabilitation addresses these common secondary conditions, using hands-on therapy such as massage, thermotherapy (ice or heat) or therapeutic laser (which increases cellular energy, decreases inflammation and improves blood flow).

Most of our rehabilitation patients really come to enjoy their time with us, and why not? Liberal doses of praise, lots of attention and plenty of treats seem to win over even the most skeptical pet!

For more information on rehabilitative therapy, visit the rehabilitation page at www.northstarvets.com or call us at 609.259.8300.

Pamela Levin, DVM, CVA, CCRT
Dr. Levin earned her Bachelor of Science degree in Animal Science from the University of New Hampshire in 1992. She graduated from Ross University, School of Veterinary Medicine in 1998 after completing her senior clinical rotations at Oklahoma State University. Dr. Levin has practiced as a small animal general practitioner and emergency and critical care veterinarian in New York, New Jersey, California, and Massachusetts. Pam has served as Director of Emergency Medicine at a small animal referral and emergency hospital in Massachusetts. Dr. Levin received her Certification in Veterinary Acupuncture in 2009 through The International Veterinary Acupuncture Society and her Certification in Canine Rehabilitation Therapy in 2011 through the Canine Rehabilitation Institute. Prior to joining NorthStar VETS in 2011, Dr. Levin served as staff acupuncturist at a small animal referral and emergency hospital in New Jersey. Dr. Levin’s areas of interest include improving patient’s quality of life though pain management, therapeutic exercise, and noninvasive alternative therapies. She is a member of the American Veterinary Medical Association, New Jersey Veterinary Medical Association, American Academy of Veterinary Acupuncture, International Veterinary Acupuncture Society, American Association of Rehabilitation Veterinarians, and the International Veterinary Academy of Pain Management.

Decorations

Cats love to play with tinsel and ribbon. Try to keep pets from playing with these decorations as they can quickly and easily become what’s called a linear foreign body, which means something stuck in the esophagus or intestines.

Some pets, especially puppies, will chew on Christmas lights and wires. In addition to the obvious electric shock risk posed by this, pets can also be burned in their mouth, and experience pulmonary edema, which is fluid accumulation in the lungs.

Plants

Poinsettias (Euphorbia pulcherrima) are mildly toxic to animals and pets should be discouraged from eating them. Additionally, the water at the base of Christmas trees can cause gastrointestinal upset to pets, and pet owners should do all they can to keep pets from drinking it.

Food

Chocolate and certain nuts can be toxic to pets, especially dogs. The main chemical in chocolate that creates toxicity is called theobromine. Dogs who eat too much chocolate, especially if it is dark chocolate or baker’s chocolate, may experience tremors and heart abnormalities. This can be life threatening to your pet.

Also, while many people enjoy sharing table food with pets at a holiday meal, limit it to just a couple of tablespoons. Pets are more sensitive to sudden dietary changes and fatty foods, and can experience pancreatitis, which is an inflammation of the pancreas. Pancreatitis can be life threatening.

And never give bones to your pets! They can splinter and do damage to the intestines as they pass through your pet, or get stuck and become a foreign body, which may require surgery to remove.

Other threats

Anti-freeze is always an issue for pets when the weather gets cold. The active component of anti-freeze, a chemical called ethylene glycol, causes kidney failure. The good news is that there is an antidote, so get your pet to the veterinary emergency hospital as soon as you can as the situation becomes more life-threatening after several hours. Because ethylene glycol is an alcohol-based chemical, pets who have consumed anti-freeze appear “drunk.”

Call the animal poison control or pet poison hotlines if you think your pet has eaten something poisonous.

By knowing what the biggest holiday threats are and taking some time to create a safer environment for your pet, you can avoid a potentially life-threatening situation for your pet. As always, be prepared and know where your nearest veterinary emergency hospital is and how to get there, and have their phone number programmed into your phone or posted on your refrigerator. You might even want to create an account for them to speed up the check-in process.

If NorthStar VETS is your nearest veterinary emergency hospital, know that we are always open, day and night, even through the holidays. Our phone number is 609.259.8300.

Since last Monday, this place has been where you’d be most likely to find Rebecca Boncheck, VMD, a veterinarian and owner of the Chesterfield Veterinary Clinic in Bordentown, NJ. Dr. Boncheck is also in charge of the Burlington County Animal Response Team (CART), a county organization that works with similar groups state-wide to help animals in the event of a disaster such as Hurricane Sandy. For the past week, she has done everything from setting up the dog, cat and isolation wards, to examining and treating animals, managing an inventory of donated items, and building all of the protocols, processes and volunteer staff needed to make this animal relief effort a well-oiled machine. A few days in, she feels like the operation is working well, although there are still needs to be met. Because of what she’s built, many similar organizations will be looking to Dr. Boncheck in the coming months as a thought-leader on the best way to set up and run a shelter like this in the face of a disaster.

The outpouring of support at this shelter in Burlington Township has been tremendous, and so has been the need. As people displaced by the storm, some left only with their closest family members and the clothes on their back, try to cope and figure out their next move, the veterinary and local volunteers do everything they can to make the experience as comfortable as possible for the pets brought in with their owners. Animals here receive exams and necessary treatments, they get walked and played with by volunteers, and see their owners every day.

What these shelters and organizations have been doing around the state to help animals get rescued, cared for and reunited with their owners has been amazing. NorthStar VETS has been approved to send its staff down to help, and everyone from the NorthStar VETS Chief of Staff, Dr. Daniel Stobie, to the veterinary technician team, have all had a chance to visit and help these animals in need.

To donate needed items to this shelter, contact the Fountain of Life, located at 2035 Columbus Road, Burlington Township, NJ 08016.
     

“In response to the tropical storm Sandy potentially affecting the NJ area, the Burlington County Animal Response Team (CART) has been notified of an expected pet-friendly emergency evacuation center to open Monday, October 29, 2012 at the location named below. CART is equipped to provide temporary shelter and basic first aid to animals at this location.

If the need arises, the Burlington CART will refer any emergent care cases to NorthStar VETS from its evacuation center. For more information including evacuation preparedness with your pet, please see the CART Facebook page at http://www.facebook.com/BurlingtonCountyAnimalResponseTeamcart

The address is: Fountain of LIFE

2035 Columbus Road

Burlington Township, NJ 08016

Shelter will open at 8am Monday October 29, 2012.”

The above information comes from Dr. Rebecca Boncheck, Deputy Veterinarian for the New Jersey Disaster Response Team. NorthStar VETS has been identified as the closest 24 hour, emergency veterinary facility to this shelter and will be their first line in handling illness and injuries that the shelter is not equipped to handle. Also, NorthStar VETS is the designated location for overflow of this facility in the event that the volume of pets requiring shelter exceeds their capacity. In addition, NorthStar VETS is prepared to board any pets from other veterinary practices or the general public in need of shelter as well.

With Halloween approaching, the criticalists at NorthStar VETS thought this would be a good time to pool their collective experiences and offer some suggestions for managing dogs that ingest chocolate. The tips and points provided below are as much based on their experiences in various settings treating many affected dogs, as what may be found in texts and citations. With that, they hope some of the information below will be helpful to you.

Understanding chocolate toxicity in pets

• In most chocolate compounds, theobromine is the predominant toxic compound, with methylxanthines and caffeine present in much lower concentrations.
• It is not always clear how much or what kind of chocolate a pet consumed after-the-fact. For animals that ingested chocolate from home-made products or from bakeries, it is especially difficult to identify the exact amount of chocolate used.
• The Veterinary Information Network (VIN) provides easy-to-use calculators to determine if a pet consumed a toxic amount of chocolate. There are excellent tables and calculators available for smart phones, as well. Regardless, using good clinical judgment, assessing each patient individually and often is more important than trying to forecast what signs to expect and when. As with other intoxications, there is lots of interpatient variability. We become concerned about toxicity and likely need for inpatient observation when dogs eat more than 2 oz/kg of milk chocolate.

Diagnosing chocolate toxicity in pets

• While not something to share with every client, chocolate ingestion is seldom fatal if pets are treated symptomatically, appropriately and aggressively, even when early decontamination is not possible. When dogs succumb, it is generally due to arrhythmias, respiratory failure, or severe pancreatitis.
• Typically, chocolate produces marked emesis such that the actual exposure is less than what the dog actually ate.
• EXCEPTION: YOUNG LAB RETRIEVERS and the like!
• If they do vomit, they will often eat it if not careful.
• Almost all dogs will become mildly symptomatic 2-3 hours after ingestion.
• Initial clinical signs (observed within 6-8 hours after ingestion): polydipsia, restlessness, vomiting and diarrhea.
• Polyuria, tremors, tachycardia, tachypnea, hyperthermia, arrhythmias are generally seen after 8-12 hours.
• If a client suspects chocolate ingestion, and no signs are observed six hours after suspected exposure, it is unlikely this dog will become sick.
• Some intoxicated dogs will have “paradoxic” signs, e.g.
  miosis, sedation, bradycardia – Absence of classic signs does not rule out exposure.
• Because of high fat content of many chocolate products, pancreatitis may develop 24-48 hours following ingestion.

Treating chocolate toxicity in pets

• In general 3% hydrogen peroxide is the only product we occasionally advise for “at home” emesis induction. Salt and ipecac are not recommended. 1 ml/lb, up to a maximum of 45 mls (3 tablespoons) may be given safely.
• Outdated peroxide (flat, not fizzing) will not work. Peroxide may be mixed with a small amount of peanut butter, yogurt or vanilla ice cream without compromising efficacy.
• Peroxide is more likely to work if the dog is walked after it is given versus sitting in one place after administration.
• Apomorphine (dogs only) may be given in-hospital, either IV or conjunctival. In rare cases when marked sedation is observed, naloxone will reverse depression induced by apomorphine, but may actually exaggerate the vomiting. This is not ideal, as repeated vomiting will cause further dehydration in an already compromised pet. Bottom line: try not to reverse unless the pet is obtunded or hypoventilating.
• Typical apomorphine IV doses are 0.03 to 0.04 mg/kg.
• Xylazine (0.44mg/kg) IM is the emetic of choice in cats (for which chocolate ingestion is admittedly rare).
• Consider prescribing maropitant (Cerenia) or dolasetron (Anzemet) after emesis has been successful to help with patient comfort, without the risks associated with naloxone as noted above.
• Theobromine has a long half-life and undergoes entero-hepatic recirculation. Thus, repeated doses of activated charcoal (AC) are given. Recommendations vary, but we give 1-2 g/kg (~5 ml/lb of Toxiban) every 4-6 hours (while symptomatic), almost never needing to be given after 24 hours following ingestion. Most activated charcoal suspensions are available with and without cathartic.
• A generally safe rule of thumb (that may be applied to most, though not all intoxications) is to give AC with a cathartic (e.g. sorbitol or MgSO4) for the first dose, then AC WITHOUT a cathartic for subsequent doses.
• While acepromazine is not an anxiolytic in the dog, it appears to be very effective for managing the marked agitation observed with this toxicity. We do not give acepromazine in rare cases when seizures occur. We prefer to manage seizures in this setting with a constant rate infusion of benzodiazepine, such as diazepam. Propofol is also reasonable, but its use requires uninterrupted patient observation (for apnea).
• Barbiturates are likely effective but currently not available.
• Muscle tremors often respond to methocarbamol. If the injectable form is not available or IV access is not possible, tablets can be crushed and given per rectum.
• Try to avoid aggressive cooling measures in hyperthermic dogs, such as cold water baths.
• We do not treat modest tachycardia; however a heart rate > 160 beats/min in a dog with associated symptoms should probably be treated. Some sources advise using metoprolol, or other seldom prescribed anti-arrhythmics not stocked in most practices. Propranolol, to effect, is acceptable, and can be given rectally if other access not available.
• Theobromine accumulates in urine and can be re-absorbed through the bladder wall. Thus, dogs should be walked hourly. If recumbent, place a urinary catheter and evacuate the bladder hourly or continuously (closed collection system).

NorthStar VETS criticalists and emergency veterinarians are always happy to speak with you if you have concerns about any of your patients – please call us – we don’t bite – not even at Halloween!

Reid Groman, DVM, DACVIM, DACVECC
Diplomate, American College of Veterinary Emergency and Critical Care
Originally from Long Island, NY, Dr. Groman received his veterinary degree from Colorado State University in 1994. After completing an internship at Texas A&M University, he worked in general practice for two years only to return to the university to complete a residency in internal medicine in 2000. Because of his love of learning, Dr. Groman then went on to pursue and complete his residency in emergency medicine at the University of Pennsylvania in 2003. His passion for kidney disease led him to a fellowship in renal medicine and hemodialysis at the University of California-Davis in 2003.

Prior to joining NorthStar in October 2010, Dr. Groman spent eight years on clinical faculty at the University of Pennsylvania, where he remains an adjunct clinical assistant professor helping to mold future veterinarians. Dr. Groman is active on several committees within ACVIM and ACVECC. His professional interests include acute kidney disease, extracorporeal therapies, and general emergency medicine. Outside of work, Dr Groman likes golfing, hiking, and traveling with friends and family.

Joshua Portner, DVM, DACVECC
Diplomate, American College of Veterinary Emergency and Critical Care
Dr. Portner grew up in Southern New Hampshire. He obtained his bachelor’s degree in Biology/All-College Honors from Canisius College in Buffalo, New York, and his veterinary degree from Tufts University School of Veterinary Medicine in Massachusetts in 2004. After graduation from Tufts University, Dr. Portner completed a rotating internship in small animal medicine and surgery at Alameda East Veterinary Hospital in Denver, Colorado, and went on to complete his residency in Emergency and Critical Care at Ocean State Veterinary Specialists in Rhode Island in July of 2008. In 2009, Dr. Portner passed the specialist certification examination and became board certified in Emergency and Critical Care Medicine.

Dr. Portner has special interests in mechanical ventilation, nutrition for critical patients, and transfusion medicine. Along with membership in the Veterinary Emergency and Critical Care Society (VECCS), American Veterinary Medical Association (AVMA), and the New Jersey Veterinary Medical Association (NJVMA), he has also been a member of the International Veterinary Academy of Pain Management (IVAPM) and the International Sled Dog Veterinary Medical Association (ISDVMA), as well as several state associations. During his residency, he was a member of the Rhode Island Disaster Response Team, which is an organization responsible for providing medical care to sick and injured animals during a state of emergency.

Dr. Portner joined the NorthStar VETS team in November of 2008. He is currently an active member of the Policy and Procedure Comittee and runs the Blood Donor Program for the hospital. Dr. Portner has led several lectures for technicians and doctors in the hospital, as well as for members of our referral community. Most recently, he has become a member of the hospital’s Infection Control Comittee and was the lead team member during the control of a canine influenza outbreak in the central NJ region. Dr. Portner is currently working on a few publications for veterinary journals, one of which is expected to be published in 2010. In his spare time, he keeps busy by building furniture, playing indoor soccer, shooting archery, and going to the movies.