5 Safe Chew Toys that Veterinarians Give to Their Own Dogs and Cats

Veterinarians know what toys are safe for their pet to play with. As a follow up to the blog on what not to let your dog or cat chew on,  I asked several veterinarians and veterinary technicians to tell me what they consider acceptable toys for their own dogs and cats.* Here are the top 5 items they prefer:

The Classic Kong

Kong: The Kong products seem to top everyone’s list as  safe, durable, and fun toys for dogs. Fill the classic Kong with peanut butter and kibble, put it in the freezer overnight, and let your dog go to town. They even make a blue Kong that is radio-opaque so in the unlikely event that it is fragmented and eaten it will be visible on x-ray films.

Goughnut stick

Goughnuts: These durable toys are the favorite of some of the vets I asked. The interior of the sticks and other toys are red so that the owner can easily see if the toy has been damaged and needs to be taken away from the dog.

Kong Pajama Buddy

Kong Pajama Buddy: Fill these with catnip to make them an attractive toy for your cat. One vet told me her cat even takes them camping!

Orka Dog Toys: Like the Kong, these tough toys come in variable shapes and can be filled to treats to enhance and make them more interesting.

Busy Buddies: The Kibble Nibble toy is filled with dry dog kibble. Bits of kibble drop out as the dog rolls the toy around the floor. Warning: dogs get pretty good at efficiently getting the dry food to fly out of the toy, but at least they’re getting some exercise!

*Disclaimer: although these products are considered safer than other commonly used chew toys, supervision of your dog or cat when playing with or chewing on an item is highly recommended. Make sure to offer an appropriate size of toy that cannot be swallowed whole by your pet.

10 Things Your Dog or Cat Should Never Play With or Chew On

I have been a veterinary surgeon since 1984, so I’ve spent almost 30 years surgically removing objects lodged in the mouth, esophagus, stomach, and intestines from dogs and cats. A simple lesson I’ve learned from this experience is: when dogs and cats swallow something other than food, it can kill them. Here are 10 common items that can cause serious problems for your dog or cat:

Bones: That’s right, “A dog and his bone” are not a good combination. They love to chew them but if swallowed whole or in fragments they can lodge in the esophagus, intestine or rectum and cause severe problems. Substitute real bones with large nylon bones that they can’t break up or swallow.

A fish hook lodged in the esophagus of a dog. Surgical removal was required.

Fish hooks: Dogs and cats eat them because they taste like fish. Fish hooks are good at catching fish but will lodge in the mouth, esophagus, stomach, or intestine requiring either endoscopic or surgical removal.

Undergarments: Don’t ask why, but dogs love to eat our “unmentionables”. They get stuck in the stomach or intestine and if not removed quickly they can cause perforation of the bowel and life threatening infection.

Panty hose being surgically removed from the intestine of a dog.

Keep tampons out of reach too!

 

Corn cob in the intestine of a dog. 

Corn cobs: Dogs can swallow them whole and they will plug up the guts in no time.

Baby pacifiers: Kids and pets are usually a great combination, but keep an eye on pacifiers and bottle nipples. Dogs love them as appetizers.

 

A scarf being removed from the intestine of a dog.

Linear foreign bodies: socks, strings, towels, plastic bags, rug fragments: A kitten playing with a ball of yarn is cute, but not if kitty eats it. Strings wrap around cats’ tongues and can extend from there all the way to the large intestine. Dogs will eat all kinds of stringy materials. The foreign bodies will make the intestines bunch up and perforate and are an extremely serious problem. That string they use to tie up your Thanksgiving turkey? Guess who would love to eat it?

Radiograph of a dog with gravel in his stomach and intestine. 

Rocks: “If he chews it, he will swallow it.” Give your dog safer alternatives to satisfy his chewing desires. Don’t discard meat drippings on your gravel driveway.

 

Radiograph of a dog with a ball in his stomach

Balls: tennis balls, golf balls, rubber balls; anything that he can fragment or swallow, he will.  Playing ball with your retriever is fine but when the game is over, put the ball away.

Gorilla Glue: Dogs like the taste so they will eat the entire bottle. Then the glue rapidly expands and hardens and forms a mold of the inside of the stomach requiring surgical removal. Save yourself some money and your dog some pain and suffering by keeping this stuff away from him.

 

A large stick being removed from the chest cavity of a dog.

Sticks: Dogs love to chew them and run with them. Both are bad. Splinters from the sticks get jammed into their throat or esophagus and cause severe infection. Small splinters may migrate from the throat to remote areas of the body causing a chronic infection and draining tracts.

Conclusion: Keep risky items away from your pets. When you give your dog or cat something to play with, ask yourself: can he swallow this? If the answer is yes, take it away. Even when you give your dogs or cats a safe toy, supervise them. Talk to your veterinarian about safe chew toys for your pets. Your furry loved one will thank you by living a longer life.

Questions are welcome, and please share any experiences you've had that we can all learn from.

New Poll; which GI surgeries are you comfortable performing?

I put a new poll in the upper right hand corner of the website. I am very interested to see what everyone is comfortable doing in gastrointestinal surgery. Multiple answers can be selected.

Thanks!

As a follow up to the last blog, I posted a question for my colleagues concerning use of NSAIDs in dogs. I was interested in which drugs they prefer and if they have had any cases that developed gastric ulcers. Thirteen people responded and offered a variety of experiences. Several cases of gastric ulcers were described but not associated with one particular drug. Some NSAIDs not labeled for use in animals were administered by owners without the advice of their veterinarian to patients that subsequently developed ulcers. Some of the veterinarians even had gastric ulcers develop in their own dogs while administering appropriately labeled drugs.

For the specific comments go to this link: https://www.facebook.com/DrStephenBirchardVeterinaryCE?ref=hl

Add your own experience and clinical preferences to the discussion by posting a comment. 

Also, vote on which NSAID you prefer to prescribe by selecting an item in the poll seen in the upper right side of the blog page. (If viewing the blog on your mobile phone, switch to "web version" to see the poll on the page.)

NSAID Induced Gastric Ulcers in Dogs

Fig 1: Perforating gastric ulcer of the pyloric antrum (arrow)

Non-steroidal antinflammatory drugs (NSAIDs) that are labeled for dogs have markedly improved management of chronic pain. However NSAIDs make the stomach more prone to ulceration by several mechanisms including mucosal irritation, reduction in prostaglandin production, decreasing gastric blood flow, and interfering with repair of superficial injury to the mucosa. This is a well-established phenomenon in humans and animals. A clinical study in dogs many years ago found that the most common causes of non-neoplastic ulcers in dogs were NSAIDS and hepatic disease.¹  In the past few years, most likely due to widespread and chronic use of NSAIDS in dogs, we have seen an alarming number of dogs with perforating gastric ulcers. Ulcers have been associated with multiple drugs and in some cases due to more than one type of NSAID being used concurrently or a NSAID used with a corticosteroid drug.

Fig 2: The forceps is demonstrating the full thickness ulcer

Diagnosis

The dogs with perforating gastric ulcers present with variable signs that include vomiting, anorexia, lethargy, and abdominal pain. Abdominal radiographs frequently show pneumo-peritoneum and loss of serosal detail. (Fig. 3) Emergency abdominal exploratory is indicated.

Fig 3:Right lateral abdominal radiograph of a dog with
pneumoperitoneum. Note the intraabdominal air visible under the
crura of the diaphragm. (arrows) Radiograph courtesy of Dr. David Biller
Kansas State University College of Veterinary Medicine

Surgery

The perforating ulcers tend to be located at the lesser curvature of the pyloric antrum very close to the pylorus. (Fig. 1-2) Inflammation and omental and serosal adhesions are commonly found on the affected area.  Generalized peritonitis is usually present with serosal inflammation and peritoneal effusion.

After performing a complete surgical exploratory attention is focused on the ulcer. Adhesions are removed and the edges of the ulcer are debrided. The edges of the ulcer tend to be very thickened and friable. This resected tissue is saved and submitted for histopathology to rule out malignancy. Samples of peritoneal fluid are submitted for culture and sensitivity.

Fig 4: Closure of gastric ulcer using a local full thickness flap.

To close the ulcer I have found it helpful to develop a full thickness local advancement flap of pyloric antrum and move it to the site of the defect. (Fig. 4) Closure is with 3-0 or 4-0 PDS in a simple interrupted pattern.  A Jackson-Pratt (closed suction) drain is placed in the abdomen to remove fluid and is left in place for several days.  Postoperative intensive care is required for management of the peritonitis including fluid therapy, nutritional therapy, antibiotics, and gastric antacids and protectants.

Prevention

Prevention of this potentially life threatening complication of NSAID administration should be considered for all dogs and cats receiving these drugs.

Recommendations to prevent gastric ulcers secondary to NSAIDS:

• Allow a “wash-out” period of 3-5 days when changing from 1 NSAID to another;
• Never prescribe more than 1 NSAID at a time;
• Never administer a NSAID and a corticosteroid at the same time ²;
• Avoid using NSAIDs in dogs with gastrointestinal disease or after gastrointestinal surgery of any kind;
• Avoid using NSAIDs in dogs with mast cell tumors (histamine release by the tumor can cause gastrointestinal irritation);
• Avoid administering NSAIDs to animals that are anorexic.

 References

Stanton ME, Bright RM. Gastroduodenal ulceration in dogs. Retrospective study of 43 cases and literature review. J Vet Intern Med. 1989 Oct-Dec;3(4):238-44.

Boston SE, Moens NM, Kruth SA, Southorn EP. Endoscopic evaluation of the gastroduodenal mucosa to determine the safety of short-term concurrent administration of meloxicam and dexamethasone in healthy dogs. Am J Vet Res. 2003 Nov;64(11):1369-75.

The Story of Crystal, The Chicken That Ate Metal

Crystal
(This really is Crystal, not some random picture from the internet.)

I guess you could say she was into “heavy metal”, but not the musical kind. She was a pet Rhode Island Red chicken (above). The fact that she had a name was a clue that she was not just your run of the mill member of a flock. She presented to the Veterinary Hospital at Ohio State many years ago for treatment of suspected gastrointestinal foreign bodies. Our avian veterinarian, Dr. Barb Oglesbee, admitted Crystal and did a diagnostic evaluation. After determining that foreign material was present in her GI tract, she performed endoscopy under general anesthesia and removed multiple metallic foreign bodies from the crop and proventriculus.

Metallic foreign bodies removed from Crystal's crop and proventriculus
by endoscopy. The nickel is shown for sizing purposes only.

However, one piece of metal remained that could not be removed by endoscopy. Dr. Oglesbee came to me for a surgical consult. My first reaction was: “Really? You want me to do an abdominal exploratory on a chicken?” I had done surgery on birds before but never on a chicken. All veterinarians know that sometimes you have to go outside of your comfort zone and do what needs to be done.

Crystal was still under anesthesia from the endoscopy so she was transported to the surgical area and her abdomen plucked and prepped for surgery. I ran to my office to do a quick avian abdominal anatomy review, developed an impromptu plan and returned to the surgical prep area to get the surgical team ready.

Basic anatomy of the chicken. 
www.poultryhub.org

We positioned Crystal in dorsal recumbency and did a ventral abdominal midline approach. A nail was immediately found protruding from the gizzard, and black caseous debris was present around the gizzard in the peritoneal cavity. 

Nail protruding through the gizzard (arrows). Black caseous
debris is due to leakage from the gizzard.

We performed a “gizzard-otomy” to remove the nail and closed the gizzard with simple interrupted absorbable sutures. Inverting suture patterns would have been impossible on this very muscular organ.  We then flushed the peritoneal cavity and did a routine closure of the abdomen. I did not place a drain in the abdomen since bandaging the abdomen would have been difficult and removal of the drain by the patient seemed like a good possibility.

The nail and other metallic debris removed from Crystal's gizzard.
The dime is for sizing purposes only.
(Crystal did not eat money.)
(Well considering the bill for surgery maybe she did!)

One of the interesting things that occurred during the surgery on Crystal was related to the hemostasis. As is done routinely in surgery we used electrocautery to control bleeding. When we used it on Crystal, particularly in the muscle, we became aware of something. The smell of cautery on the muscle was like fried chicken! I guess that's because it was . . . fried chicken! I can honestly say it was the first time that operating on a patient stimulated my appetitie!

Amazingly, Crystal made a full recovery with no complications. This was incredible considering she had a perforated gizzard and septic peritonitis. She returned home and probably started searching for more metal. 

For so many reasons, I will never forget this patient.

Case Outcome: Shih Tzu with chronic vomiting

A cranial abdominal mass or enlarged pylorus was seen on  the lateral abdominal plain film. (arrows)
Radio-opaque calculi were present in the urinary bladder.

A filling defect (arrows) in the pyloric antrum was seen on the upper GI barium series.

The filling defect was also seen in this VD projection of the upper GI series. (arrows)

Gastric endoscopy revealed hypertrophied mucosa in the pyloric antrum and pylorus. (arrow)

Abdominal exploratory was performed and the pylorus and antrum incised.
Severe hypertrophy of the mucosa was seen. (arrows)

Full thickness biopsies of the pylorus were obtained and a Y-U pyloroplasty was performed.

A cystotomy to remove the calculi was performed. The dog also had a portosystemic shunt and a gall bladder mucocele. An ameroid constrictor was placed around the shunt and a cholecystectomy was done. (How's that for a abdominal surgery combo?) Histopathology of the pylorus revealed changes consistent with chronic hypertrophic pyloric gastropathy. Gall bladder histopathology was consistent with a mucocele. Calculi analysis was urate and struvite in composition. The Shih Tzu did well postoperatively, lived an additional 1 and 1/2 years, and then died of unknown causes.

For more information on this disease and the surgical treatment see:
Johnson SE, Sherding RG, and Bright RM. Diseases of the Stomach, in Saunders Manual of Small Animal Practice, 3rd edition, eds Birchard SJ and Sherding RG, Elsevier, St. Louis, pg. 664.

How did you do on the case?

Stay tuned for more gastric surgery blogs including some updates on Gastric Dilatation Volvulus. 

What's Your Diagnosis?

This is an 11 year old female spayed Shih Tzu with a 2 month history of intermittent vomiting. The vomitus sometimes looks like coffee grounds. She had a right sided enucleation 2 years ago that was unrelated to her current problem.

Physical examination was unremarkable except for the absent right eye.

A CBC showed mild neutrophilia and serum chemistry profile was normal. A urinalysis was also normal.

Plain film radiographs, abdominal ultrasound, and an upper GI study with barium were performed:

Area between the cross marks in the pylorus

What further diagnostics would you do?
What are your differential diagnoses?
What definitive treatment would you recommend? (hint: it probably involves some kind of surgery.)

Answers in the next blog!

Fine tuning surgical removal of gastric foreign bodies

Today's blog may seem a little basic but it's a good start to what will be several more blogs describing gastric surgical techniques such as debridement and closure of full thickness ulcers, incisional gastropexy to prevent gastric dilatation volvulus, and pyloroplasty for pyloric hypertrophy.
Gastric surgery requires adequate surgical exposure.  The ventral midline abdominal approach should begin at the xyphoid cartilage and extend beyond the umbilicus.  Self-retaining retractors (e.g. Balfour) are very helpful in the exposure. 

Contamination of the abdomen with stomach contents can be minimized by isolating the stomach from the remainder of the abdomen with laparotomy sponges, using stay sutures to elevate the gastrotomy incision, and using suction to remove stomach debris and fluid.  If an upper GI radiographic contrast study was performed preoperatively, prevent spillage of barium into the peritoneal cavity.

Always do a thorough examination of all abdominal organs. Besides the stomach, pay particular attention to the intestines, liver, and pancreas.  In cases of gastric neoplasia, close examination of regional lymph nodes and liver must be done to check for metastatic disease.

Indications for gastrotomy include gastric foreign body, distal esophageal foreign body, or gastric biopsy.  Figures 1-4 are from a dog whose owners discarded turkey drippings onto the gravel driveway on Thanksgiving Day. That was the tastiest driveway the dog had ever eaten. (Yes, the gravel was removed from the stomach using a sterile teaspoon.)

Make the gastrotomy incision in a relatively avascular area, halfway between the lesser and greater curvature.  Traditional gastrotomy closure is a two-layer inverting pattern such as a Cushing (Fig 5) followed with a Lembert pattern (Fig 6).  Absorbable sutures such as Monocryl or PDS on taper needles are acceptable for closure. Be sure to penetrate the submucosal layer of the stomach with the suture. After taking a bite of the tissue, if you can see the suture through the tissue the submucosa has probably not been included in the suture bite. Some surgeons prefer to close the gastrotomy incision with a simple continuous of the full thickness gastric wall followed by a Cushing pattern of the seromuscular layer. Dr Becky Ball, also a surgeon at Circle City Veterinary Specialty Hospital, prefers that technique.

Figures 1 and 2

Figures 3 and 4

Figure 5

Figure 6