Where Did That Toy Go?

As an emergency vet, one of the most common medical problems that we see in the clinic is the case of a dog or cat who's chewed up a toy or eaten something they shouldn't and is now vomiting. Just last week I used an endoscope to remove a hair scrunchie and pieces of a boot from the stomach of a little Boston terrier. He'd been vomiting for the 2 days before his exam and he had suspicious findings on his X-rays. Once we got in there with the scope, the cause was obvious and it came out in about 20 minutes without needing any surgery. He went home in a few hours.

Dogs (and to a lesser degree, cats) assume that the world is edible until proven otherwise. In nature, this was probably a good strategy, since the ancient plains had far fewer toxins and threats to a dog's health than do our modern homes. You never know - that plant that you chewed up could be nutritious! Nowadays, with lots of synthetic materials that can't be digested, plus some toxins produced thanks to modern chemistry, it's far more a game of Russian roulette and many dogs end up with an intestinal blockage - or worse - when they try and find out just how edible that shoe is.

The Cost of a Cheap Chew Toy

Intestinal foreign bodies tend to fall into 2 categories - ones that are just there, or just passing through, and ones that are causing a blockage. When an intestinal blockage happens, things can so south in a hurry. As food and by products of digestion get trapped behind the blockage, pressure builds up which can cause the intestines to rupture given enough time (as little as a couple of days). Once the intestines start leaking, a bad situation just got desperately worse. Peritonitis is the medical term for widespread infection in the abdominal cavity, and almost half of the patients with peritonitis from a ruptured intestine don't survive. Surgery is a necessity, and several days of ICU care are often needed for recovery. Good thing I was able to get the scrunchie out with the scope and was able to avoid all that mess in my patient from last week!

Some foreign bodies can cause a blockage, but peritonitis hasn't set in yet. For these cases, sometimes the object will move on it's own, but sometimes it just stays there, risking peritonitis. In most cases, it's a good idea to surgically remove a foreign body once it's seen on Xrays or ultrasound, but the cost of surgery can be prohibitive for some.

Surgery for a non-complicated foreign body removal can be about $1,000 - 1,500, while surgery and treatment for peritonitis can cost $4,000 - 10,000 with no guarantee of success. If the object is in the stomach, you can often get at it with an endoscope - but many clinics do not carry this piece of high-tech equipment. The advantage of the endoscope isn't so much decreased cost, since it costs about the same as surgery for an uncomplicated foreign body, just that the recovery is so much faster since there is no cutting or surgery involved.

How to Avoid Surgery

So how do dogs and cats get these obstructions? Chewing up and ingesting (eating) toys is a big way. Most of those toys that you see lining the aisles at the local pet store are not fit for pets and represent a huge health hazard. The problem is that there's no agency (like the consumer products safety commission for people) to evaluate and judge the safety of pet toys - they just go up on the shelf and into your dog's intestine, where we hope they don't cause a problem. So here's my rule #1 of dog toy purchasing (and you're probably not going to like it): don't ever buy a dog toy that your dog can chew a part off that's larger than a pea. Sorry. That means all cloth toys, anything with a squeaker, cheap rubber toys with a thin wall - all of it. Dogs will often chew up a cloth toy to get to the plastic squeaker inside and that little squeaker is the perfect size to lodge itself in the intestines and start all the trouble.

Tough and hard (but flexible) toys, and ones that can be only gradually 'shaved' down by chewing are OK. But skip the squeaky Bart Simpson toy and protect your dog's health.

Dogs also get foreign body obstructions (like my little friend last week) by chewing up household items or getting into the garbage. And I've seen it all - watches, every brand of shoe, underwear, corks, pacifiers...this list goes on and on and includes just about everything but the kitchen sink. And someday, I'll probably pull that out of a dog, too.

What about Cats?

Cats, like in most things, are a bit of a special case. Cats are often too discriminating to chew up a boot. A cat's special kind of obstruction is known as a 'linear foreign body' and it usually happens when they swallow a string, thread, ribbon or piece of dental floss. The string gets hung up at one end and the intestines creep along it like a curtain bunching up along a curtain rod. The string saws through the intestines and you end up with lots of little leaks and deadly peritonitis again.

So for cats, all those adorable Currier and Ives prints of kitten playing with a ball of yarn should really have a bright red "NO" symbol printed on them - string is that dangerous for cats. Little fuzzy mice, laser pointers, and catnip make fine and safe toys for cats, but skip the string.

Keep your dog or cat safe. Avoid any toy that they might chew up and eat, and stick to the firm rubber or plastic ones that can only be gradually whittled down. And don't ever let your cat play with string! Keep these simple rules in mind and your dog or cat will thank you and you can skip a trip the animal ER.

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