In this issue: SAGE Advice 

SAGE Client Update:
Dangers of Mushroom Toxicity 

With the wet weather returning (thank goodness), SAGE wanted to remind our clients about the potential of poisonous mushrooms popping up in your yard or at your neighborhood park. Poisonous mushrooms are an uncommon cause of liver failure in many parts of the country, but are one of the major causes of acute liver failure in dogs in our San Mateo practice. Amanita mushrooms are common in Northern California. Clinical signs of their ingestion include vomiting, abdominal pain, lethargy, bleeding, jaundice, and death. Initial signs of illness usually occur within 6 to 12 hours of the pet eating the mushroom. The ingestion of just one mushroom can cause death in an otherwise healthy 50 lb. dog.

If a mushroom is ingested, vomiting should be induced immediately. If the patient is already sick when presented, aggressive liver support must be provided with IV fluids, antibiotics, milk thistle, Vitamin E, and potentially other products such as antioxidants and blood products. Milk thistle has been used for centuries in patients with liver disease and seems to protect the liver if given in high doses very soon after ingestion of the mushroom. The prognosis depends on the amount of poison ingested, the extent of liver damage, and the administration of early and aggressive medical care.

At SAGE Veterinary Centers, testing for the amanita toxin can be performed on the bile or urine of a patient and submitted to the UC Davis toxicology laboratory. Mushroom identification can be performed at Oregon State University Veterinary School. (This does not mean that aggressive therapy can be postponed until the final test results are known, however.) In our San Mateo practice, we have seen mushroom toxicity patients from Burlingame to Portola Valley. The mushroom seems particularly prevalent on the Peninsula and in the general Bay Area.  

This is a big deal. I actually run out to my front yard every morning to look for mushrooms popping up in the mulch. They seem to come out of nowhere every night. I felt so terrible for one of my clients last summer when she said, "I am a smart woman. How did I not know that I had something growing in my backyard that would kill my dog?" Most people are likely unaware that mushrooms in a yard or park can be so dangerous, so we want to help spread the word. 

One of our veterinary nurses put together a few pictures of some of the common poisonous mushrooms in the Bay Area. This is not meant to be an exhaustive list. If you have a question regarding a specific mushroom, you may
want to contact the North American Mycological Association.

There are four different groups of mushrooms in the SF Bay Area that contain alpha-amanitin that may cause liver failure.   

Clockwise from top left: Amanita phalloides are associated with trees and are typically found near oak trees. Lepiota are small, with a pink-brown scaly cap. These can grow in lawns and in the forest, and are not associated with trees. Galerina autumnalis  is a brown-spored mushroom that grows on branches and woodchips. Pholiota is a group of mushrooms that are brown-spored, grow in soil, and have a flat to conical cap.

How to Survive Your Pet's Therapeutic Confinement

Lissa Richardson, DVM, Diplomate ACVS
SAGE Concord

Your dog has just been diagnosed with a ligament tear and will need surgery and two months of "bed rest" to heal. How in the world do you do this to your best friend? Your rambunctious cat has just been diagnosed with a lump that needs to be removed surgically and will need two weeks of no jumping. How do you tell your cat that?

You will feel like you want to tell your pet what is going on and why there's a sudden lock down. You are worried that they will feel like you are punishing them. You are worried that they might be traumatized by all of it. The SAGE doctors and staff can be very helpful here. Many of us have had to take a dose of our own medicine and have gone through this with our own pets.

Here are a few things to consider:

First, your pets have never had an explanation for anything that happens to them and they are not expecting it or needing it now. Animals live mostly in the moment and are not concerned with why things are happening. In fact, we find them inspiring as they navigate their path to healing without any "Why me?" baggage.

Second, dogs live in a hierarchical society. They are not used to a democracy. You, as the owner, are the alpha dog and what you say goes. Be cheerful but adamant about the new change in routine. You know that what you are doing is in your pet's best interest in the long run. If you are apologetic and worry, they can pick up on this emotion and wonder what they did that was wrong. Be optimistic, knowing that the restriction will be temporary. Your dog will pick up on this emotion.

Cats are a different story. They are masters at manipulating their human companions. The old joke is that dogs have owners while cats have staff. Do your best to make them comfortable, but don't fall under their hypnotic stares and let them outside while they are healing. Be strong. Give them catnip. Many cats seem to take to the "room service" when they are confined to a small area. Some will truly meow and meow if they are confined.

There is also a time and place for low-dose sedation. About two weeks after surgery, many animals are feeling much better and want to start to run and jump. If they need prolonged confinement, then judicious sedation can help a lot. The medications that we use here at SAGE are non-addicting and can help to turn down the cabin fever a notch or two.

Avoiding Holiday Safety Pitfalls 

The holidays are just around the corner, and though our emergency service is open 24/7, including Christmas and New Year's Day, you probably don't want to see us at that time. SAGE Dublin's Dr. Erin Nohava notes that in addition to ER visits caused by foreign body obstructions and toxicities from swallowing things they shouldn't, another common reason dogs visit the ER around this time of year is that they have gotten into fights with other animals in the same house. So before you take Fido to Grandma's for family dinner, here are a few techniques from the ASPCA for safely introducing dogs to each other:  

• Don't force unfamiliar dogs to interact. It's okay if they ignore each other or if one dog seems reluctant to interact with the other. Give them time to get comfortable.
• Closely observe the dogs' body language as it can help you understand what they're feeling. Be aware of stiff body movements, tensed mouths or teeth-baring, growls, and prolonged staring. These are all signs that a dog is feeling threatened or aggressive. If you see this type of body language, give the dogs more distance from each other.
• If the dogs are very different in age or energy level, it's a good idea to give the older or less energetic dog a private space where he can enjoy rest and down time.