PANEL RESULTS FROM INTERNATIONAL SOCIETY OF FELINE MEDICINE (ISFM)

AND AMERICAN ASSOCIATION OF FELINE PRACTITIONERS (AAFP)

Chart for client handout:  http://www.catvets.com/uploads/PDF/NSAIDsClient%20Handout.pdf

 

 

 

CONTRAINDICATIONS/VERY CAREFUL MONITORING AND DOSAGE (or use opiates):

• Cardiac Drugs:  Diuretics, ACE inhibitors, β-blockers, digoxin (complications from dehydration, blood pressure changes, or competitive protein binding)
• Glucocorticoids (GI complications)
• Drugs that are highly protein bound and have low margin of safety (NSAIDS are highly protein bound and can displace other protein bound drugs such as warfarin, digoxin¸anticonvulsants like phenobarbital, and chemotherapeutic agents.)

SYMPTOMS OF PAIN IN CATS may be very subtle.  They include withdrawing from attention, decreased mobility, reduced interactions with humans or other pets, poor appetite, and aggression.

CAUSES OF PAIN IN CATS

• Degenerative Joint Disease(DJD) is the most common.  It is thought to affect 60 – 90% of cats in the spine or legs.   Treat for obesity, give mild exercise, make environmental modifications to assist mobility.
• Neoplasiatreatment is sometimes aided by concurrent treatment with NSAIDS.  This is in addition to making the cat feel better.
• Trauma
• Lymphoplasmacytic gingivo-stomatitis
• Idiopathic cystitis
• Skin disease
• Uveitis
• Fever

CYCLO-OXYGENASE/LIPOXYGENASE  INHIBITION (COX/LOX) enzymescause pain by aiding in production of prostaglandins and leukotrienes.  NSAIDS block the actions of COX and LOX enzymes.  Prostaglandins play important roles in normal physiology involving many systems such as vascular homeostasis, gastroprotection, renal developmenet and blood flow, blood clotting, bone metabolism, wound healing, nerve development and growth, and immune responses.  They are also involved in the pathological processes of pain and inflammation and cancer progression.

• COX-1 is found at pretty constant levels in most tissues unless it is increased due to an exciting factor causing it to help create inflammation.  COX-1 is most usefully active in protecting cells in the gastric mucosa, maintaining normal platelet function, and maintaining renal perfusion.
• COX-2 shares with the COX-1 enzyme, many of the above-mentioned functions and is found at fairly constant tissue levels.  COX-2, however, rises to dramatically higher levels in the presence of inflammation.  It is more of an induced enzyme.
• COX-3 is now recognized as  a variant of COX-1 and it seems to have a role in central pain control.
• 5-LOX enzymes are being researched now but no COX/LOX inhibitory drugs are approved at this time.

SIDE EFFECTS OF NSAIDS occur when the normal physiological roles of prostaglandins and leukotrienes are interrupted.  Inhibition of COX-1 functions seem to be most problematic.  So, drugs were developed that were called either COX-1 sparing or COX-2 preferential NSAIDS.   Debate exists as to whether this is the best approach.  COX-1 and COX-2 enzymes may affect the same tissues in different ways, requiring both to be present for normal function.  This leads some to prefer drugs that inhibit both COX-1 and COX-2  (dual inhibitors). 

 Researchers are looking at inhibition of COX leading to increased LOX activity, another problem in the mix.  Also, since most NSAIDS are weak acids, ion trapping can occur when extracellular pH is lower than intracellular, affecting the liklihood of side effects.  There is little solid research in felines and in vitro studies do not always predict in vivo responses.  Therefor, NSAID product choice and dose for each unique individual results in great variability in the severity or liklihood of adverse drug side effects.  ISFM/AAFP panel recommends that there is little predictably deciding data from cats and that probably the COX-2 preferential drugs may be only slightly superior if at all in blocking pain with the least adverse side effects. 

CLIENT COMPLIANCE is always an issue.  Meloxicam liquid is suggested to be highly palatable for cats.  Other drugs can be compounded.  Liquid products can be measured in increments that may more accurately fit the weight of the patient.  Send home a clearly marked syringe for accurate dosing.

DOSAGE AND TIMINGare very important because some of these drugs are slowly metabolized. 

• Most NSAIDS are metabolized through the liver and so liver function affects dose.  Piroxicam and meloxicam ar metabolized by oxidation instead.
• There is no practical way to predict which cats may be fast or slow metabolizers.  Use the lowest dose that works.
• If the cat will not eat, do NOT administer the NSAID.
• Dosage may change with time.  Periodically, withdraw or reduce dosage of NSAID to see if its continued use at that specific dose is justified.  Use criteria of mobility, activity, grooming, and temperament to assess level of comfort.  Encourage clients to journal under these four headings.
• Peaks and troughs in NSAID activity may be timed to either fit the patient’s preferred schedule of activitiy OR may be timed so that the patient is least active when the owner is sleeping.
• Obese cats should initially have NSAID dosages determined by what their ideal body weight might be.
• When adjusting NSAID dosages, prefer to change amount of drug rather than interval of dosing.
• Panel does not recommend pulse therapy unless underlying cause of pain waxes and wanes.

SWITCHING DRUGS has little evidence-based data. 

• Switching from aspirin to NSAIDS requires washout period of 7 to 10 days.
• Switching between NSAIDS thought to need washout of 3 to 5 days or potentially even longer if previous NSAID has a prolonged half-life.

CONCOMITTANT DISEASES AND CONDITIONS affect dosage and usefulness of NSAIDS.  DO NOT give NSAIDS if patient does not eat.

• Renal Diseasemay force a lowered NSAID dose because normal adequate kidney function may depend upon the normal positive effect of prostaglandins.
  • Be especially careful to have adequate organ perfusion during surgery.  Prostaglandin levels become crucial when there is low renal blood flow and so NSAIDS can cause Acute Kidney Failure (AKF).
  • Annectdotally, Chronic Kidney Disease (CKD) patients generally showed no worsening of blood chemistries when they were maintained on oral meloxicam at .02 mg/kg/day or on oral piroxicam at doses of .2 to .3 mg/kg/day on long term bases.
  • Get baseline serum and urinalysis data before embarking upon long term NSAID useage.  Monitor blood chemistries regularly and respond accordingly if kidney function begins to deteriorate.  Opioid therapy may replace NSAIDS if necessary. 
  • Use wet diet to increase water consumption.
  • Extreme caution should be used when cardiac disease is also present.  Lowest possible doses and careful monitoring still allow NSAID use where needed.
  • Monitor K+.
• Gastrointestinal Disease is the most common side effect of NSAID usage in mammals.
  • Vomiting occurred in 16% of cats in one large study of piroxicam but these cats were in a cancer study and getting other drugs as well.
  • Vomiting occurred in about 4% of cats receiving .1 mg meloxicam daily over a long term.
  • Upper GI bleeding is the most common serious adverse side effect.
  • Factors increasing the risk include, age, dosage, previous NSAID GI disease, pre-existing GI ulcers, and concurrent anti-coagulant or glucorticoid use.
  • Can use a mucosal protectant such as a prostaglandin analogue (ie. misoprostol at 5 µg/kg PO q8h) or a proton pump inhibitor (ie. omeprazole at .7 to 1 mg/kg PO q24h).
  • If GI bleeding or ulceration occurs, stop NSAID until healed.  Resume carefully, using mucosal protectants listed above.
• Cardiovascular Disease patients’ risk of using NSAIDS is virtually unknown.
  • Hypertensive cats receiving NSAIDS should have BP monitored closely.
  • Titer NSAIDS to lowest possible dose.
  • High prevalence of thromboembolic disease in cats makes it questionable whether long term therapy might increase chance of embolism as it does in some humans.
• Liver Disease due to long term NSAIDS is occasional in other species and we may see it eventually in cats as NSAID therapy becomes more commonplace.
  • Monitor liver enzymes routinely.
  • Dose reduction should be considered in cats with pre-existing liver disease.  In the presence of severe liver dysfunction (eg, as evidenced by moderately to severely elevated bile acids.) and/or hypoalbuminemia (of any cause), NSAIDS should be used with extreme caution, if at all.

MONITORING CAT ON NSAIDS

 

• Before beginning treatment get good history, including all other drugs recently or currently in use.  Blood pressure reading, chemistries focused on renal and hepatic systems along with plasma proteins and hematocrit.  These considerations direct frequency of future monitoring and may impact dose or even cause the clinician to seek other remedies.
• Client information about monitoring and signed acknowledgment of risk prevent misunderstandings and help create a successful outcome.   The client should cease treatment and discuss changes with the veterinarian whenever a new problem arises.
• Routine monitoring during treatment is crucial.
  • Initial reassessment at 5 to 7 days (or sooner if complications arise) could be done in the clinic or over the phone.
  • Next reevaluation should be at 2 to 4 weeks depending upon owner’s observations and perceived risk by veterinarian.
  • Continuing reevaluations should be done every 2 to 6 months determined by informed evaluation of risks. 

PARVOVIRUS IN DOGS

THE DISEASE                                                            

INTESTINAL FORM:  Sadly, we see entirely too many cases of generally preventable parvovirus in puppies and occasionally, in unvaccinated adults.  The deadly disease usually begins with lethargy and loss of appetite and progresses to vomiting, diarrhea, severe depression, dehydration, and finally death. As the diarrhea worsens, it becomes bloody and has an extremely foul odor.  The severity of parvo disease depends upon body weight, age, environmental stresses, parasitism, other diseases, and the amount of immunity (antibodies) received from the mom.  Without veterinary intervention, most afflicted puppies will become dehydrated, lose significant amounts of body fluids, go into shock, and pass away miserably.  Unfortunately, even with treatment, a small percentage of these puppies will also die. 

     The longer the beginning of treatment is delayed, the more likely we will see an unsuccessful outcome.  Several mutations of parvovirus have occurred.  More recent mutations are more likely to cause disease and are more difficult to treat.

CARDIAC FORM:   In this rare form of parvovirus, severe inflammation kills heart muscle cells, resulting in the deaths of puppies generally younger than 8 weeks of age.  These pups exhibit extreme difficulty breathing as the heart fails.

ASYMPTOMATIC:  Inadequately vaccinated adult dogs occasionally will contract parvovirus and exhibit few or no symptoms while still shedding the disease in their stool.

 

SOURCES AND SUSCEPTIBLITY

     Unvaccinated (or recently recovered) dogs, wolves, coyotes, foxes, and other canids, are reservoirs (sources) of parvovirus.  Infection is by ingestion of the virus from feces or vomit of infected animals.  We see the disease most commonly where there are large numbers of unvaccinated dogs.  Shelters are especially at risk.  Though staff may vaccinate dogs upon arrival, new shelter residents may already be infected or may have poor immune responses because of stress, previous starvation, heavy parasitism, or other neglect.

     There seems to be a lowered resistance in some breeds, especially the black/tan varieties.  Doberman pinschers, rottweilers, pit bulls, German Shepherds, and dachshunds seem particularly prone to parvovirus.  Most victims are puppies 6 weeks to 6 months of age.

 

 

DIAGNOSIS

     Extreme lethargy, vomiting, and diarrhea in a puppy make us consider parvovirus.  Similar symptoms may accompany other conditions such as severe parasite burden, other viral or bacterial infections, hemorrhagic gastroenteritis, foreign body impaction, or physical restriction of the bowel (intussusception or tangling).  The in-house fecal “snap test” for parvo is not perfect.  It may show us a false negative because of the short time of viral shedding in the stool.  It can also indicate a false positive if the puppy has been vaccinated in the last 5 to 15 days.  Blood count, x-rays, and testing for intestinal parasites may also be helpful for a diagnosis. 

 

TIME LINE: 

·         Puppy has oral exposure to vomit or feces of another canine with parvo.  (This highly contagious virus can survive easily up to 7 months in the environment, longer if frozen in winter months.)

·         Virus is in the blood stream by 3 to 5 days.  (Usually, the puppy still seems normal at this point.)

·         The puppy begins to shed highly contagious virus in stool 4 to 5 days after exposure.

·         The puppy has early symptoms 5 to 14 days after exposure. (Rarely, early symptoms can be seen as early as 3 days after exposure.)

·         Fecal shedding of virus is much less by 14 days after exposure, generally ending completely by 3 weeks.  (Fecal material left on coat from highly viremic early diarrhea is still very contagious.)

 

TREATMENT

·         FLUID REPLACEMENT is necessary to combat losses through vomiting and diarrhea. 

o       Intravenous (directly into the blood stream) fluids are necessary in severe cases and the patient must be hospitalized.  This is the puppy’s best chance for a successful outcome.

o       Subcutaneous (under the skin) fluids are not as effective but may be used in less severe cases.  They can be done at home when the expense of veterinary intensive care is prohibitive.

To give subcutaneous fluids, pick up loose skin on the back and pop the needle through, just under the skin. Hang the bag high to speed fluid administration.  Pinch the hole shut and rub that area between your fingers as you remove the needle to keep fluids from leaking back out.  Fluids will make a bulge under the skin and will be picked up slowly into the circulation.  Try to replace the volume of fluid being lost in vomit and diarrhea plus some for maintenance.  Here are some guidelines for reasonable fluid therapy at home:                                                                                                          

PUPPY WEIGHT (LBS.)      CC’S OF FLUIDS EVERY 12 HOURS
5                                           50 to 75
10                                         100 to 150
20                                         150 to 300
40                                         200 to 400
50                                         300 to 500

If the puppy seems to deteriorate at these levels, intravenous treatment is necessary.  If fluids are accumulating at the sides of the chest and even down the legs, stop additional fluids until most of that is gone and then resume at a lower volume.  Stay in touch with your veterinarian if you have questions or if the puppy does not improve.

o       Blood transfusions from a well-vaccinated adult dog or addition of other more extreme fluid therapies may be necessary in some cases to combat shock and actual loss of protein and blood cells.

o       Oral electrolytes help with hydration once vomiting is controlled.  Pedialyte is readily available at pharmacies and can be used at a rate of two to four cc’s per pound body weight per hour depending upon the severity of fluid loss from diarrhea and vomiting.  Large volumes all at one time will stimulate vomiting.  If the puppy vomits immediately after oral fluids, discontinue them until drugs and time have lowered the sensitivity of the stomach. 

·         WARMTH (protect from temperature extremes)

o       A carefully monitored heat pad (on low setting), separated from the puppy by a thick fleece or rug may be necessary for very small patients.

o       Warm fluids by running a portion of the intravenous hose through a bowl of hot water in very depressed, cool puppies.

·         ANTIEMETICS (drugs that block vomiting—provided by your veterinarian) 

·         ANTIBIOTICS (to prevent secondary bacterial infections—provided by your veterinarian)

·         ANALGESICS (for pain control—provided by your veterinarian only in extreme cases because of expense)

·         DEWORMING (may have to wait a bit until the bowel is recovering)

 

FEEDING

     In mild cases, using drugs to block vomiting may be effective enough so the puppy can continue to eat very small meals of bland food.  Science Diet ID, boiled hamburger and rice with the grease completely skimmed off, plain yogurt, and cottage cheese all contain valuable nutrients to keep up the energy of a growing puppy.  Avoid spicy foods like liverwurst, greasy meat, and other high fat foods. 

    We suggest that you give your antiemetic (Cerenia or metoclopromide) and then wait half an hour before first trying to feed your puppy.  If your puppy vomits immediately after eating a very small meal, stop feeding it and continue with the hydration and the drug regimen prescribed by your veterinarian.  When you see 6 to 8 hours without vomiting, you may try another very small snack (a teaspoon to a tablespoon, depending upon the size of your puppy).  If that stays down for an hour, repeat that small amount every hour or two as you accustom the upset stomach to food again.  Offer water or Pedialyte in the same way, just a little at a time, increasing as the puppy is able to keep it down. 

 

DISINFECTION 

     One part bleach to thirty parts water is recommended to kill parvovirus on hard, smooth surfaces that will tolerate bleach (NEVER on a pet).  Unfortunately, that is not an option for your sofa, carpet, or the soil outside in your yard.  In these areas, clean up the actual physical residue as best you can, consider steam cleaning and quaternary ammonium cleaning products with viral capabilities indoors.  Know that parvovirus may stay in the environment a year or more in soil or other porous, difficult to clean surfaces.

     Once your puppy is recovering from parvovirus, bathe it well with antibacterial shampoo, allowing it to soak in the lather for 5 minutes before rinsing.  Repeat a week later.  Make sure that your puppy does not get chilled during its bath.  Be a good citizen by not bringing your puppy around others for a couple of months after its recovery from parvovirus.

 

NEW PUPPY DANGER

     After you have had a puppy with parvovirus on your premises, do NOT bring other unvaccinated puppies into that environment for a year or more!  If you do get another puppy, leave it at the breeder’s facility or farm it out to friends/family until it is at least 4 months old and has had multiple vaccinations against parvo.  For most breeds, we feel pretty confident that receiving the final “puppy shot” at 4 months will be protective.  However, for some of the breeds more prone to parvo, an extra vaccination at 22 weeks (5 ½ months) would give more assured protection.

 

PREVENTION

     Protection from parvovirus begins with the mom.  Many careful breeders booster a bitch’s vaccinations just before breeding her.  This will give her colostrum maximum antibodies against disease.  The mom needs to be in good health to whelp vigorous puppies and to have plenty of milk for them.  Puppies need to get a generous dose of colostrum right away after birth.  Their ability to absorb its protective antibodies decreases to nearly zero by the end of the first 24 hours.

     Antibodies from the mom are living cells pre-programmed to fight specific diseases.  Parvovirus vaccine simulates the actual viral disease.  If we give the vaccine too early (before 6 weeks), the mother’s antibodies from the colostrum attack the vaccine and they inactivate each other.  With time, the antibodies die off naturally.   Since we don’t know exactly when each puppy’s maternal protection gets too low to be useful, we give a series of “puppy shots” that include parvo.  Typically, these begin at 6 to 8 weeks and are given every 2 to 3 weeks, depending upon likelihood of exposure.  Keep puppies away from other puppies or places where dogs congregate during this sensitive period.  We assume in most breeds that the final “puppy shot” is given when the puppy is 4 months old and should protect it from parvovirus.  High risk breeds may opt for another at 22 weeks (5 ½ months) as well.

Gretchen Wilson DVM

Blame it on global warming (warmer winters), less snow, increased deer populations, or natural tick population cycles; Lyme disease caused by a Borrelia species and spread by feeding ticks, is on the rise and has been for several years. Canines typically do not show symptoms of early infection as humans do. Instead, they commonly develop fever, lamenesses, arthritis, swollen and painful lymph nodes, and general soreness 2 to 6 months after contracting the disease. Less often, some animals go on to develop neurologic disease , severe, generally fatal kidney disease or heart complications.

This upsurge in Lyme disease cases was first noted in our clinic in 2004 with about 60 cases. In the ten years previous to that added together, we had not seen nearly 60 cases. In 2005, we saw double that number. This year, we already have diagnosed 41 positives for Lyme disease, many with the typical symptoms, some seemingly normal. The test only tells us that they are exposed and may or may not develop signs of disease.

The drugs used to treat Lyme disease remain the same as in recent years. However, the suggested dosage of doxycycline has doubled and the length of the treatment has increased. Current research indicates that the Borrelia organism may never be completely eliminated from the system, simply retreating into tissues like cartilage that have a poorer blood supply to carry the antibiotics. Here, it repeatedly changes its capsule components to evade the immune system of its host. Interestingly, the antibody defenses created by the dog in response to Lyme vaccines, only work within the tick itself. As the first antibody laden blood is ingested by the tick, these immune defenses interfere with functions of the Borrelia within the tick, blocking transmission to the dog.

Unfortunately, the Borrelia organism that causes Lyme disease has some new tick-born friends in our state with increasing numbers of cases as well. Our bumper crop of varying species of ticks is busily infecting animals (and people) with Erlichia, Anaplasmosis, Babesia, and Rocky Mountain Spotted Fever as well. These may cause different combinations of the symptoms of Lyme disease listed above as well as more cases of neurological disease, eye lesions, and bleeding and blood disorders. Some dogs are found to be positive for more than one of these diseases.

Short of moving out of the area, we do have some things that will greatly decrease the chances of infection with any of these organisms. First of all, limit exposure. Ticks come out of tall grass, so, if plausible, mow or spray areas frequented by yourself and your pets. Do not depend upon being able to find and remove ticks before the 24 to 48 hours of attachment thought necessary for disease transmission. Many animals are infected by immature forms or small species that are very difficult to see even in short-coated pets. Spray any attached tick with a tick killing product before removing it. You will be more likely to get all of the head. Veterinarians often have to finish removing embedded tick heads that have caused severe inflammation.

Begin to vaccinate as early as 9 weeks of age and yearly for Lyme disease in dogs, even if you do not think they will find ticks. We have had to treat Chihuahuas and poms and other small house dogs that owners thought were never exposed. For dogs or cats, as young as 8 weeks, use fipronil (Front-Line Plus®) spot-on treatment monthly, avoiding bathing or swimming for a few days before or after application. In the last couple of years, we have seen ticks all through the winter months. It is very important to continue application throughout the year, especially for outdoor pets. Most of the cases we are seeing now were probably infected during this past winter.

Remember that with fipronil, the tick needs to bite the dog to be killed. So, if your pet is in a severe exposure situation, also use a flea and tick collar containing amitraz (Preventic®) to repel ticks even before they bite (and before they are carried into the house, potentially exposing you and your family).

Veterinarians have a simple in-house test for Lyme and erlichiosis (also includes heartworm). By the middle of this summer, this test should also include anaplasmosis. This test diagnoses current infections in pets that are ill and symptomatic, but also is an important screening tool to let us know of a problem during the 2 to 6 months before signs of disease are likely to appear. This increases likelihood of successful treatment and may even allow your veterinarian to prevent the death of your pet. Remember that this article pertains primarily to dogs and somewhat to cats, but we hope all of you out there are taking proper precautions for yourselves as well!

Our pets often want to eat what we do and that can be unhealthy or even deadly. "Table scraps" are frequently too spicy or too fatty for them, causing vomiting and diarrhea and even life-threatening pancreatitis. Hot dogs, gravies, poultry skins, fat trimmings, and casseroles are common sources of such problems and also the accompanying obesity that seems to plague many pets and owners alike. However, there are a number of human foods which are surprisingly toxic to our good four-legged friends.

Xylitol is an artificial sweetener found in gum, mints, vitamins, baked goods, and beverages. Read your labels! It is much more rapidly absorbed in dogs than in people and will cause low blood sugar and sudden, severe liver disease. These can lead to vomiting, staggering, collapse, seizures, and death. Ingestion of as little as .008 oz. of the actual sweetener per pound of pet or let's say 5 cookies or 40 pieces of gum for your 25 pound dog, can kill.

Raisins and grapes can cause vomiting and diarrhea leading to rapid kidney failure within 24 hours. As few as 5 or 6 of these fruits can cause the death of some average cats or small dogs.

Onions and garlic are sometimes eaten as they are flavored with meat juices. Dogs and cats need to eat them in fairly large amounts to see problems. They can cause digestive upsets first and then, may progress to destruction of red blood cells, anemia, and in extreme cases, death. Many pets will treat themselves by vomiting anything so spicy on their own.

Chocolate and caffeine (methylxanthines) are deadly in fairly small amounts. Dark chocolate is a more concentrated source than the light milk chocolate. Your dearest dog only needs to eat .11 oz. of baker's chocolate per pound of body weight (or 2.75 oz. for that 25 pound Rover) to possibly die. It is not quite so bad with semi-sweet chocolate at .33 oz. per pound of pup (8.4 oz. for a 25 pound dog). Milk chocolate weighs in at 1 oz. per dog pound potentially lethal (25 oz. for a 25 pound dog). Symptoms of toxicity are seizures, urination, diarrhea, and vomiting.

Bread dough has yeast that ferments in the stomach and releases an alcohol (ethanol) causing alcohol poisoning. In the warm stomach environment, it also rises rapidly, causing extreme expansion of the stomach which leads to serious crowding of the lungs in the chest. The alcohol causes symptoms of drunkenness and the expansion of the dough in the stomach eventually results in unproductive attempts to vomit and difficulty breathing. Induction of vomiting must be done right away, before the bites of bread dough become too large to pass back out of the stomach.

Drugs (over the counter and prescription) cause a variety of problems when eaten accidentally or when given as a treatment. Tylenol and ibuprofen are toxic to both dogs and cats, aspirin is toxic to cats and all are commonly misused. (Pepto-Bismol and Kaopectate have aspirin in them!) Always check with your veterinarian before using any drugs and realize that pet dosages may vary greatly from human ones if they are tolerated at all.

Alcoholic beverages are obviously not suited for our pets. It is not cute or intelligent to leave alcohol where pets can lap it or to offer any amounts to them. This is especially true of our very small friends. If you offer your 5 pound Yorkie an ounce of beer and you weigh 200 pounds, you will have given him a dose equivalent to your drinking 40 oz. of beer in an equal amount of time. That is binge drinking and we all know where it can lead.

Hallucinogenics (marijuana, cocaine, mushrooms, etc) can lead to rapid heart rates, confusion, incoordination, seizures, and death. Remember that body size has a lot to do with the amount necessary for a lethal dose. Yes, sadly, we occasionally see these cases.

When faced with the possibility of any of the above ingestions, involve your veterinarian in treatment decisions right away. Remember that minimizing time is extremely important and you may be asked to immediately induce vomiting by syringing or spooning hydrogen peroxide into your pet's mouth, tilting the head back slightly, and being very careful to do small portions at a time to allow normal breathing. Amounts vary and you may continue adding more until vomiting does occur. It generally takes about 1/8 to 2/3 cup in that 25 pound pooch. Unfortunately, alcohol is absorbed so quickly that by the time you know you have a problem, it may be already too late for vomiting to reduce absorption.

So, know what toxins are in your house and do not tempt fate by leaving them easily accessible by your "four-legged children". Keep some hydrogen peroxide and your veterinarian's phone number readily available. Notice any odd behaviors and investigate possible causes. Give those good buddies a big hug and know that you are doing your best to keep them safe and happy!