We nearly lost blind Widget over the Thanksgiving holiday. That she survived was one part luck and four parts state-of-the-art, round-the-clock veterinary care. I took the photo this afternoon of our vet, Dr. Jennifer Rockwell of Montana Veterinary Specialists in Helena, with Widget. Jennifer spent her holiday saving Widget's life.
And it was something so stupid, and so apparently harmless, as a pack of Trident sugarless chewing gum that nearly killed her. The lethal ingredient was xylitol, an artificial sweetener used in an increasing number of everyday household products, from chewing gum to toothpaste to store-bought muffins and cookies. Humans can ingest xylitol with no apparent ill-effects, while it can be fatal to dogs. Xylitol is, for our canine friends, a poison. In "routine" cases, xylitol causes hypoglycemia, and in higher doses, it can cause acute liver failure and thus death. (Its effect on cats is unknown.)
Alayne and I were only vaguely aware that there was some "issue" about dogs and sugarless gum, but we learned from this terrible experience that it's only sugarless gum with xylitol that is the danger. An incredible danger.
Late on Wednesday afternoon, Alayne heard a racket coming from her closet in our bedroom. She walked in to find clothes strewn all over the floor, the step-ladder knocked over, and Widget happily smacking her lips. Widget is what we call a "miner" because she loves to root around in dog crates and closets, under chairs and shelves, always in search of an overlooked dog cookie or something edible. A surprise treat.
Alayne thought it was odd Widget was smacking her lips and wondered what on earth she had found in the closet to eat. She pulled the clothing away and found the packaging from the pack of chewing gum on the floor, with only one stick of gum left. It was a blueberry-flavored sugarless version of Trident. It must have fallen out of a purse or a pant pocket. What's even more a fluke -- here's the irony of this entire story -- is that Alayne typically never buys sugarless gum but the "real thing." She figures she must have purchased this pack of gum by mistake months ago and never used it because it was the sugarless type.
It was just pure luck Alayne happened to find Widget in the act. Otherwise, we would never have known, and an hour or two later, we would have found her in hypoglycemic distress.
Staring at the empty gum packaging, Alayne recalled hearing or reading something about sugarless gum, and we called our vet clinic in Helena right away. Dr. Jennifer Rockwell asked us to tell her what the ingredients were, and when I read off "xylitol" as the third item, she said, "Uh oh." She told me to induce vomiting immediately by giving Widget 15 cc's of hydrogen peroxide orally, and then rush her over to the clinic. (It's at times like this, faced with a medical emergency and a 70-mile drive over mountain passes on two-lane highways, that we could really use a helicopter!)
I filled a syringe with the hydrogen peroxide, propped Widget on my lap, and Alayne held her still while I squirted it into her mouth. A few minutes later she was vomiting all over the living room floor. (Linoleum -- no worries!) I pulled on a pair of surgical gloves and sifted through her vomit, trying to figure out how much gum she had eaten. All we had was the empty package from the closet, and knowing how many sticks of gum she ate would tell Jennifer the dose of xylitol she had ingested. As I ran my hands through the wet piles of puke, I could smell an intense odor of ... blueberry. Dang. I found multiple pieces of gum fragments, some still in their individual wrappers. But the blueberry smell was pungent.
Alayne ran to the vehicle shed and brought the truck over to the house while I gathered my coat and other things for the trip. We put Widget in the back seat and then I drove at a mad clip for Helena. Of course, this being the evening before Thanksgiving, it was dark and our usually empty rural highways were crowded with holiday traffic. (Helicopter, anyone?)
Jennifer and her vet techs were waiting for us at the clinic. The first thing Jennifer did was administer another medication to induce a final round of vomiting, just in case anything was still left in Widget's stomach. Then she put Widget on IVs with a dextrose drip and began treating her for hypoglycemia, or low blood sugar.
Why hypoglycemia? As Jennifer explained it to me, for unknown reasons the canine body -- unlike the human body -- interprets the xylitol as exactly the opposite of what it is. In other words, rather than "reading" it as a sugarless compound, the canine body sees it as an onrush of sugar, or glucose. This triggers a massive release of insulin to help the body to soak up and use that extra glucose. Well, there is no extra glucose in the bloodstream, so the insulin release causes the body to absorb the existing normal amount of glucose in the bloodstream. Suddenly the animal is at dangerously low levels of blood sugar, which can cause shock and seizures and, if untreated, send the animal into a coma and even death.
But Jennifer told me it would be a couple of days before we knew if Widget would survive. That's because in some cases, dogs can develop acute liver failure from xylitol ingestion, but the first signs to show up -- in elevated liver enzymes -- don't necessarily appear until 12 to 24 hours, and sometimes even later. Only until we still had normal liver enzyme levels 48 hours post-ingestion could we start to breathe easier. Jennifer calculated that based on the amount of gum we think Widget ate -- xylitol was the third ingredient, not the first one, listed on the Trident packaging, which means a lower dose -- Widget was at 0.5 g/kg of xylitol, right at the threshold for risk of liver failure.
Jennifer also began treating Widget with therapies for liver support as a precaution, and she stayed up with Widget throughout Wednesday night. From then on, we anxiously awaited Jennifer's daily call with the latest CBC and chem panel results. But not until Saturday, when Widget's liver enzymes were still normal, could Jennifer tell us, "I think our little girl is going to be okay."
This morning, at 10 a.m., Jennifer called to say, "Widget is ready to go home today!" We left her at the clinic for a few more hours to continue weaning her off the IV fluids she has been on since Wednesday evening (too abrupt a withdrawal can make the kidneys unhappy), and I told Jennifer I would meet her at the clinic in Helena at 2 p.m. this afternoon. But I asked her to tell Widget we saved some Thanksgiving dinner for her!
This post is already too long, so rather than getting into more detail on xylitol poisoning in dogs, here are links to two articles on this subject from reputable veterinary sources. I would definitely recommend you read these yourself and then give a copy to your vet. The dangers of xylitol poisoning, and how to treat it, are still not widely known, even in the vet community.
New findings on the effects of xylitol ingestion in dogs. This is the definitive article from the journal Veterinary Medicine, December 2006, by Eric K. Dunayer, MS, VMD, DABT, DABVT. This is the one your vet needs. It has treatment protocols in it. Dr. Dunayer is a board-certified veterinary toxicologist at the ASPCA's Animal Poison Control Center and the leading expert on this subject. He also authored a paper on xylitol and liver failure in dogs that appeared in the Journal of the American Veterinary Medical Association in 2006. While that paper is not publicly available online, it is excerpted in this Veterinary Medicine article.
Xylitol toxicosis. This is a Web page from VeterinaryPartner.com, which is owned by the Veterinary Information Network, or VIN, the veterinary community's online forum for sharing the latest in medical knowledge. Written by Carlye Rose DVM, DABVP, it has a graph showing the dramatic rise in xylitol poisoning reported to the Animal Poison Control Center -- from 711 cases in 2006, to 1,944 in 2007, and to an estimated 4,000 cases in 2008! Widget will be one of those cases.
This last article has a final line that is worth highlighting:
Xylitol poisoning is preventable. Xylitol-containing foods or gums should not be consumed in pet-owning households.
I took this photo of Widget enjoying her special welcome-home Thanksgiving dinner this evening:
And Jennifer, bless her heart, is finally going to have her Thanksgiving celebration tonight, too. It's been a long five days for all of us!