Very often, in veterinary medicine, we’re dealing with the unknown, making decisions without all the information. We discuss the likelihood of various scenarios with a worried owner to guide our choices, and we have wished countless times for the ability to predict the future. A recent patient, Jack, was a great example of this.
Jack is a very excitable spaniel who loves nothing more than spending time with his family and getting into mischief. When his owners had a weekend away, he went to stay with his owner’s mum to have a little holiday of his own. When he was collected on the Monday he was bright as a button but the following day he started to develop vomiting and diarrhoea. His concerned owners asked their mum whether Jack could have eaten anything unusual, and it came to light was that Jack had been caught stealing grapes from a vine in the garden.
Jack’s owners called us for advice and alarm bells rang immediately because grapes are potentially toxic to dogs. Jack was brought into the surgery so that we could assess him. When we examined Jack, he was lively and all his vital signs were normal. Aside from his vomiting and diarrhoea, he was showing no symptoms at home that flagged any concerns.
We were worried however. We know that grapes can potentially cause serious illness in dogs – grapes are amongst the top ten poisons that the Veterinary Poisons Information Service regularly advise upon – but the problem is that grape toxicity is still a bit of a mystery. We don’t understand yet why grapes cause toxic effects in dogs. Furthermore, there appears to be no correlation between quantity of grapes eaten and the severity of poisoning. There are reports of severe illness in dogs after eating just a few grapes, while others have been only mildly affected after eating large quantities. Some dogs appear completely immune, having eaten lots of grapes with no signs of toxicity at all. We do know that raisins, being dried grapes, can be even more of a problem as they are often more readily consumed by dogs, in fruit cakes or mince pies for example.
When toxicity does occur it can be really serious, starting with vomiting and diarrhoea within 6-24 hours of consumption, but sometimes progressing to acute renal failure within 48-72 hours. And once the symptoms of acute renal failure have developed, the prognosis becomes very poor – treatment may not work and the toxicity can become fatal.
So here we had a dilemma with Jack. We knew he had eaten grapes and that they would already have been digested, but there were plenty of unknowns. Perhaps the grapes were not even a problem and this was just a simple coincidental tummy upset. He may have been showing digestive symptoms of toxicity but would recover with no problems, or he may go on to develop life-threatening renal failure. And if this last scenario was the case then we couldn’t just wait to see if he developed symptoms as it would then have been too late to treat him properly.
We discussed these concerns with Jack’s owner and together decided to take a blood sample to assess how his kidneys were functioning at the time. But here we had another complication, this time presented by Jack himself. While Jack is a really lovely dog he does get very anxious coming to the vets. He panics, hiding behind his owner, and the more we try to handle him the more he struggles. His owners have worked very hard on this behaviour, bringing him into the practice for socialisation visits, and have made great progress but we have learnt that, with Jack, a hands-off approach is most successful. This did present a challenge as we needed to get a blood sample. It was time for a spot of ‘dog-whispering’.
We spent a bit of time with Jack in quiet area of the practice and found he settled very well with some cuddles on his terms. As he began to trust us, and without having his owner to rush to, he was turning to us for reassurance and, thankfully, we could get the sample we needed with minimal restraint. We all breathed a sigh of relief when the tests were normal.
We discussed the next steps with his owner, as Jack was still potentially within the danger period. We considered putting Jack on a drip to support his kidneys in case of damage but, because of his anxiety and because he was so well at the time, we opted to send him home for his owners to monitor him closely. They knew that if he took a turn for the worse or if there was any change in his urine production or thirst then they should contact us immediately.
Jack had a quiet night and his owners had no need to call the duty vet. The following day we saw him again to repeat the patient process of getting a blood sample. Once again, his results were clear and we were happy that he was out of danger.
Dealing with these uncertainties is a daily part of our job, and not something we can learn from a textbook. Over time it gets easier. Developing a ‘gut instinct’ helps, but we always focus primarily on available evidence and a logical assessment of likelihoods and risk. Sometimes we are wrong, of course, but by working closely with owners and discussing all possibilities, we usually find the right approach for each patient, being ready to adapt if necessary. With Jack, hindsight tells us now that the most he would have suffered as a result of guzzling those grapes was a nasty tummy upset. However, thanks to his owner’s dedication and understanding, we were able to protect him from a much more serious outcome had the scenario been worse. We do know one thing for certain – he won’t be allowed to nibble on those grapevines again!
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