Strategy #1: Don’t. Don’t pill the cat. No, I’m not telling you to toss your veterinarian’s prescription in the bin and hope that thoughts and prayers will cure the illness instead. Rather, I am telling you that there are alternatives. Sometimes. People often assume that liquid medication is the main alternative, but I don’t actually recommend that in most cases. There are a few drugs on the market that are flavoured with cats in mind and that require only small volumes to be administered, and these may be realistic, but many others are disastrous. At least with a pill you know where you stand — either it’s in or it’s out. With liquid, if they spit some out, you don’t know how much of the dose they got. And it’s messy. And your cat will hate you even more because the flavours of liquids are often more intense.
No, instead I suggest you ask whether the recommended medication comes as a long-acting injection (this mostly applies to antibiotics), or whether it can be made into a flavoured chewable treat. Quite a few drugs can be reformulated as treats in a surprising range of flavours. Tuna and chicken are the most popular in our practice. There’s also beef, liver, bacon, salmon and the curiously non-specific “seafood.” These can then be crumbled into similarly flavoured soft food if the cat won’t take them directly as treats. The main downside of flavoured chews is that they need to be made by a compounding pharmacist, so there can be an extra wait and some extra expense.
Some people have luck with a product called Pill Pockets, which are ultra-tasty soft treats with a hollow part you hide the pill in when your cat is not looking. Incidentally, just hiding a pill in food very rarely works for cats. Some can tell even when you’re just thinking about putting a pill in there and will refuse to eat until you stop thinking about it. And even if hiding the pill works at first, they usually catch on fairly soon, so it’s only really feasible to try for short courses of medication.
Another don’t-pill-the-cat solution is transdermal gel. Some drugs can be made into a gel, again by a compounding pharmacist, which is then applied to the ear and absorbs through the skin that way. This would be ideal if it weren’t for the fact that skin absorption varies somewhat between individuals, so more monitoring is often needed. Also, it only works for a few medications. Nonetheless, it’s worth asking your veterinarian about this option, especially for chronic meds.
Strategy #2: If you have to pill your cat, or for some dark reason actually prefer to pill your cat, there is a trick to it. I’m right handed, so I’ll put the cat up on a table on my left side, with my left elbow keeping him against my body. I will have the pill ready between the thumb and forefinger of my right hand. I will then hold the top of his head with my left hand and gently tilt his head up. Next, I will use the middle finger of my right hand to pry his mouth open by pushing it into the space behind his fang teeth. (Stop laughing, I’m being serious.) As soon as he opens his mouth, you need to put the pill as far back over his tongue as you can and then immediately close the mouth. You should have a syringe or eyedropper ready with two or three millilitres of water. Squirt that in quickly by pushing it into the corner of his mouth, into his cheek. Blowing on the nose sometimes encourages him to swallow. And sometimes it encourages him to swat you. But the water is important, not only to make him swallow, but also because pills can otherwise sometimes become lodged partway down the esophagus (food tube), which can lead to serious complications.
Incidentally, as you are probably aware, most dogs are totally different. An article entitled “Pilling the Dog” would be exactly four words long: “Wiener. Cheese. Peanut Butter.”
The Firehose and the Pudding
Most people are looking at this title and thinking to themselves, “That’s weird. Firehose? Pudding? How do these relate to each other, or to pets or veterinarians? And he used the word ‘firehose’ in a previous essay. Is it about that?”
On the other hand, people who work in vet clinics are groaning lightly and face-palming because they know exactly what I am going to write about. I am going to write about diarrhea. And I’m going to try hard not to be too gross about it. It’s tough for me, but I am going to try hard.
Even though it may seem obvious, let’s start with a definition. From a medical perspective, diarrhea is stool that has enough liquid in it that it can no longer keep its happy log shape. A single abnormal bowel movement could be a fluke, but if it happens more than a couple times in a row, we can properly call it diarrhea. And if you want to get all nerdy and technical about it, you can refer to the Bristol Stool Scale and score the poops from one to seven. (If you have taken a moment to look at it online — you keener, you — please note that where it says “lacking fibre” for stools scoring five, this just applies to humans. In animals, I would consider five to be borderline diarrhea.) Poop that scores six is what we sometimes refer to as “pudding,” and seven, if it is sprayed out, is “firehose.” That’s it for the gross bits! All done. You can read on safely now.
Once you know your pet has diarrhea, there are really just two important questions you need to consider: First, how long has it been going on? And second, does your pet have any other symptoms, or is she otherwise happy and normal?
To the first question, we’re only going to talk here about diarrhea that has been going on less than roughly two weeks. This is acute diarrhea. The word acute sometimes confuses people as some believe it means severe, but it doesn’t; it just means recent onset. Chronic diarrhea is due to a whole other set of causes, needs different tests and has different treatments. Fortunately, it is relatively rare. Acute diarrhea, on the other hand, is extremely common.
If the only symptom is diarrhea and there is no vomiting, lack of appetite or lethargy, then you can follow the advice here or just phone or email your veterinarian for their advice. There is no need to rush Billy Bob down for an urgent examination. If, however, any other symptoms are present, then it’s best to get him checked over.
Before we get to what to do, a word about causes. Acute diarrhea in previously healthy pets with no other symptoms is almost always due to either a virus or what we like to call a dietary indiscretion. Even if your pet is not in contact with other animals, viral diarrhea is still possible as these viruses can be found out in the environment and be easily transmitted on their paws (dogs especially) or on your shoes. And dietary indiscretion simply means having eaten something their system doesn’t tolerate, like five-day road-aged dead squirrel, stuffed pizza crust or a nasty random thing in the garbage (dogs especially, again). Keep in mind that what they can tolerate will change over time, so the fact that Ellie Mae did well on bacon chips for years doesn’t mean that they won’t cause diarrhea now.
Treatment for acute diarrhea is usually simple because the body has remarkable healing mechanisms. Often all we need to do is turn off the tap and power down the poop-making machine. To do this we need to temporarily replace their regular diet with a low-residue one that produces very little stool and therefore allows the gut to rest and heal. For this you have two options. You can either buy a commercial-prescription low-residue diet, such as Gastro or I/D, from your veterinarian, or you can cook for your pet. For dogs, the magic recipe is: one part extra-lean cooked ground beef (boil or fry and drain until it’s just dry meat with no fat) — or, if your dog can’t have beef, use lean chicken breast — and two parts (by volume, just eyeballing it is fine) boiled white rice (not brown).
That’s it! Frequent small meals are best. And no treats or anything else other than water to pass their lips. For cats, I usually recommend just a pure lean protein source without the rice, such as canned fish packed in water, or cooked chicken or turkey breast.
Feed this until you’ve had 48 hours without diarrhea. If it still persists after that, please call your veterinarian! There may be no stool at all during this period, but this doesn’t mean constipation; it is just the result of the low-residue diet producing very little waste. Once you’re past the two days, mix the low-residue diet 50/50 with their regular food
for a day or two before switching back completely.
One final wrinkle is that diarrhea that has been going on for a few days, but is not yet chronic, may be persisting due to dysbiosis, which is both a fun word to say and a useful one to know as it describes an imbalance in the normal gut bacteria. We are learning more and more how helpful the bacteria in the large intestine are. That dead squirrel or sidewalk virus can sometimes lead to a change in that bacterial population that impairs the gut’s ability to produce normal stools. Consequently, if a couple days of low-residue diet haven’t done the trick, your veterinarian may recommend a source of prebiotic, which is something that feeds healthy bacteria, such as canned pumpkin (weird but true), and/or a probiotic, which provides large numbers of the good bacteria. Years ago, we used to recommend yogurt for this, but fortunately there are much better, more dog and cat–specific probiotics available now from your veterinarian.
With any luck, ta-da, normal poop! (Ahem, Bristol Stool Scale three or four.)
Rainbow of Poo
Easily offended readers, or those with good taste, have probably not made it past the title to get to this warning, but as a precaution, here is the warning anyway: this piece is entirely devoted to discussing the whys and wherefores of dog poop colour. Yes, poop again. It’s really important. That human medicine does not focus on it more astonishes me.
As I did not have a dog growing up, my earliest dog memories are of my friends’ and relatives’ dogs. In particular, I remember Antje, the beautiful, big black standard poodle owned by my friend Derwin Rovers’s family. Derwin lived on the next block, and we were back and forth at each other’s houses a lot. The Rovers were Dutch and loved the Dutch-style red cabbage that is stewed with apples and turns a vibrant purple colour. Derwin’s Oma was visiting from the Netherlands, and she loved Antje. Antje loved her too. Antje loved her because Oma would feed her from the table whenever Derwin’s parents weren’t looking. One day they had this red cabbage, and Oma gave Antje rather a lot of it, plus some pork and mashed potatoes. The diarrhea was purple. Right on their white shag carpet. (This was the early 1970s, after all.) Brilliant, vivid purple. I cannot begin to explain how deeply impressive this was to a pair of six-year-old boys. Eyes wide, mouths hanging open, fingers pointing . . . this made our day. Heck, it made our month. Purple poo! Derwin, your dog had purple poo!
Fast forward 47 years, and I am still grappling with dog poo colour as not a week goes by without a question from a client about what it all means. So here, for your edification, is a field guide to the spectrum:
Brown: Let’s start with an easy one. Any shade of brown is normal. It may vary from dark to light from time to time for no particular reason, but it’s all good.
Yellow, Green or Orange: These are generally muted brownish versions of these colours, but these are also fine. You are just seeing more bile coming through. This may happen when the gut is contracting a little faster or with certain foods, but as long as it is firm, it is fine.
Red: This generates the most calls and visits as it is understandably alarming. Yes, red does mean blood. Generally, however, the red blood is in spots or streaks or as a small amount at the end of the bowel movement and should not be a cause for alarm. (If, on the other hand, the entire bowel movement is red, you are right to be alarmed, and you should call your veterinarian forthwith.) The spots and streaks just mean that the anus, rectum or last part of the colon are irritated, and that perhaps there was some straining that broke a small blood vessel. If it only happens once or twice, and the feces are otherwise OK or just a little soft, don’t worry. If it happens several times, call your veterinarian.
Purple: See Antje’s story above.
Blue: Never seen that. I have no idea. Call your veterinarian immediately.
White or Grey: Likely your dog was given a barium swallow test, and you are seeing the barium pass through. If this was not the case, you know what I’m going to say: call your veterinarian!
Black: This is the important one, really the only colour you need to watch for. If the stool is jet black like tar or molasses, and especially if it is soft and glistening and sticky, your dog may have what is called “melena” — that is, digested blood is coming from higher up in the system like the stomach or small intestine. This can be very serious as it may indicate a bleeding ulcer or tumour. Please note, however, that Pepto-Bismol can also turn the stool black.
So there you have it. While consistency, size, frequency and effort to produce are all important pieces of information regarding your dog’s stool, colour, perhaps surprisingly, is generally not. Unless the colour in question is black.
And for the cat people reading, I’ll say that more or less the same applies, although for some reason you don’t ask about it nearly as often as dog people do. A fun fact though is that if you have multiple cats and someone is pooping out of the box, but you don’t know who, you can put non-toxic sparkles in one cat’s food at a time until you see whose sparkly poo is out of the box!
No, I have not lost my mind. Yes, I am absolutely serious about all of this.
Begins with the Letter “A”
Yes, gentle readers, today we are going to talk about your pet’s anus. Frightened yet? If so, it’s not too late to bail out and check if anything new has happened on Facebook in the last 15 seconds. But if you’re still with me, you’re in for a special treat, because we are not just going to be talking about the anus generally. Nope, we’re going to be talking specifically about anal sacs.
Most people call them anal glands, but technically they are not glands, so veterinarians are taught to refer to them by their correct name: anal sacs. However, most veterinarians soon encounter the situation I did after just a couple years in practice.
“The problem is with Bella’s anal sacs,” I said.
The client raised her eyebrows and said with a smile, “You have to be very careful how you pronounce that.”
Indeed. Naïvely, I hadn’t considered this before. I don’t often blush, but this was a flaming exception. Not long after that a colleague told me that he had decided to start an explanation of why there was inflammation around a dog’s hind end by first describing the basic anatomy: “So, your dog has anal sacs . . .”
Outraged, the client interrupted, “He most certainly does not!”
So be very careful how you enunciate that third“a.” Or just call them anal glands.
And why do they have these bizarre little structures, you ask? They have them primarily to use for scent marking. All carnivores have them. Skunks have the most famous anal sacs, having turned a communication device into a weapon. But for our dogs and cats, the stinky secretions contain information about them. What information, specifically, we don’t know, but we can guess gender and perhaps some individual identification markers. This is why dogs in particular will sniff poop. They are not necessarily interested in the poop itself, but rather in the bit of anal sac material that is on it.
This then leads to the question of how these sacs normally empty. They empty when the animal has an appropriately sized bowel movement. The pressure as it passes through the anus squeezes the anal sacs. When this does not happen, perhaps because there has been diarrhea or unusually small stools, or just at random in some individuals, then the material can gradually build up and lead to problems. Typically, a dog or cat with full sacs will lick at the area or begin to “scoot” in an unmistakable fashion whereby they sit down and then drag their bottom across the ground by pulling themselves along with their front legs. Note: scooting is not caused by worms! This old myth is remarkably persistent.
If they are successful in emptying their sacs by scooting or licking, you will know — the smell is memorable. Gram for gram, anal sac secretion is one of the most potently vile substances on the planet. However, if they are unsuccessful, you should call your veterinarian. One of the more glamorous parts of our job is to put on a latex glove, apply a little lubricant
and manually express full anal sacs. And here’s the cool part — if your dog has frequent issues with full anal sacs, we can teach you how to express them at home!4 No medical degree required! It’s clearly not for everyone, though.
If the sacs remain too full for too long, the material can thicken and become difficult to express. This thickened material can also become infected, leading to the formation of an anal sac abscess. Some dogs do not give clear warning signs like scooting, so unfortunately the first thing you may notice is blood near the anus when the abscess ruptures. Luckily this is usually easily treated with antibiotics, but it can be an alarming mess in the meantime.
Prevention is of course always better than treatment. There is no foolproof way to prevent anal sacs from filling up, but adding fibre to the diet can help. A source of fibre, such as Metamucil, oat bran or canned pumpkin, can increase the bulk of the stools and thus encourage the sacs to empty naturally. Appropriate amounts vary with the source of fibre and the size of your dog, so check with your veterinarian. Incidentally, we generally do not add fibre to a cat’s diet, but cats are fortunately much less likely to have issues with their anal sacs. One final note is that in some animals, food allergies may play a role in anal sac disease, so ask your vet about that possibility.
I got through that without even telling my grossest anal sac story! I’m proud of myself.
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4For the inexplicably curious, the For Dummies series actually has an online tutorial on this.
The Accidental Veterinarian Page 8
