The following articles are accounts by owners and breeders of Scottish Terriers, detailing some of their experiences with health issues. These articles are informational only, not meant to be used for diagnostic purposes.
A Case For Earlier Detection and "Prevention" of TCC, Too Little, Too Late
Published in The Bagpiper 2005, issue 1
Copyrighted by Nancy Aaron
Several years ago when Eric, our six year old Scottie uncharacteristically peed at my feet on the living room carpet, I knew something was wrong. A few minutes later, he went through the dog door, onto the run, and attempted to urinate again, and again..... with no emission. I thought "Oh, God, not again"! By the next day we had a urinalysis finding of rafts of TCC cells, which led to the tumor-confirming ultra sound, followed by surgery to have the tumor removed from his bladder. From the time we saw him straining, to the surgery to remove the mass, only four days had elapsed. Of course, pathology confirmed what we already knew, he had transitional cell carcinoma, TCC, bladder cancer.
Four years earlier, we had lost our fourteen year old Kyly to bladder cancer. And, five years before that, we had lost eight year old Vixen to bladder cancer.
Eric's surgery was performed July 19, 2002. Eric lost his fight on July 14, 2004; five days short of what would have been the second anniversary since the beginning of his battle. Certainly, by all of the odds, by all that is right in the world, we had more than paid our share of the dues to this dreadful disease!
So, it seemed unbelievable that we could ever have another TCC victim in our clan, especially another young one. But, we do. Six year old Piper had a centimeter and a half size bladder tumor removed by laser surgery just eight days following her sixth birthday. We had seen signs of her straining days before; and knew only too well the significance of that long squat. Friends in Southern California have a six year old rescue, who also has been fighting bladder cancer, diagnosed in October of 2003. Which means that a disease thought unlikely to appear until ages 8 -10 years, is now attacking [being found in] Scotties at a much younger age. There have been reports of others diagnosed even younger. These incredible findings must be a factor [are important] for owners in scheduling health check ups; as well as what to include.
Breeder responsibility is a phrase that can mean everything to the life and well being of any "at risk" Scottie. Through the years, when we had TCC diagnosed, we alerted and advised the owners of the siblings, recommending ultrasound. For non breeding owners of Scotties, it is important that you maintain contact with the breeder. Check to get any background, as well as the current health status of the parents, their siblings, the grandparents, to see if bladder cancer has been diagnosed in that line. If so, it would be important to have an ultra sound done when the Scottie reaches four years. Had we done this with our Piper, we might have caught the mass before it developed in size, and her chances at longer life would have been far better.
AN OUNCE OF PREVENTION? Perhaps the most important part of any message addressing the topic of bladder cancer in Scotties is one that has to do with preventative measures; things that can be done to potentially reduce the possibility of any Scottie falling victim to TCC. Very little has been published, about what we, as caretakers, can do to ward off this disease. There are actions [measures] that can be taken in the day-to-day care of our Scots. And, there are diagnostic safeguards that should be considered.
"Walking the Dog "- Do you know how your dog is urinating? Do not assume, when they have yard access, that they are OK. Females tend to hold the urine more so than the males. And, holding urine can lead to myriad problems. This is why we have been walking, and observing, ours at least three times a day -- The very first thing in the morning, when the Scottie wakes up. Immediately after their late afternoon dinner. And, the very last thing at night, before going to bed. We walk until each has performed. Luckily, each has a favorite "watering" spot.
Diet and Supplements - At least three times a week feed one of the cruciform vegetables, preferably broccoli. The others are: Cabbage, and cauliflower. We feed raw broccoli, peeled stem and crown, daily. Some dogs will "pass" the stems....so there will be no benefit unless you fine chop, or blend the vegetable.
Ultra Sound - For those owners without a known bladder cancer family history, an abdominal ultra sound be done by the age of four. Because of our problems, and family history, we have had all of ours in for ultra sound. And, will repeat the procedure on a biannual basis.
Urinalysis - Based upon the recently released Purdue findings, recommendations are that any Scottie age six, or older, have a microscopic urinalysis of a free caught urine sample done every six months! In addition to possible detection of an infection, urine after being spun may reveal another potential red flag finding such as rafts, or clumps, of transitional cells. Such a finding mandates further testing such as an ultra sound to assess the possibility of TCC. Some veterinarians may recommend a urine dipstick V-BTA [veterinary bladder tumor antigen] test, as a diagnostic tool. Both false negatives, as well as false positives, have been documented, so it is not a definitive test. Also, our vet has indicated that microscopic analysis is not fail-safe. On a six month test? It is the owner's call.
Herbicides and Pesticides - Again, based upon the Purdue findings, minimize any contact with lawn and garden areas that have been treated with herbicides or pesticides. The length of time to avoid contact has not been researched and so has not determined. I would avoid all contact for all time.
TOO LITTLE, TOO LATE? If we had applied all of the preventative measures, and taken all of the recommended precautions, would it have made a difference? I honestly do not know. What I do know is that, by the time you see the overt signs, the prolonged squat [with females]... with the boys, the repeated efforts to urinate, with little flow, the release of urine inside the house when the Scottie never has accidents, or tell tale blood in the urine, the odds of providing effective treatment to prolong life have been vastly reduced. With our Eric, we knew things were terribly wrong when he urinated at our feet that day, then went out and continued trying with nothing but dribbles. With Piper, we witnessed her doing that prolonged squat, maybe only 20 seconds longer than normal, leaving only a very small pool of urine. We have never seen blood in any of our TCC Scotties' emissions, nor has there been an occult finding with their urinalysis.
By the time you see these signs, there is already something there! And, chances are with Scotties, it will be TCC. You must think that way and never be talked into a regime of antibiotic use by your vet because the urinalysis shows "infection". Sure it does, or probably does. But, also those straining signs are indicators of a far greater problem; that of TCC! You must insist that an ultra sound be done!
Many practices either have an ultra sound machine, or can refer you to a technician they use. It is a common diagnostic tool now. And, your vet should respect your request to have this diagnosis done. I certainly am not suggesting that everyone run out and get a sound done on the basis of this information. But, if there is a family history, or once your Scottie reaches six years of age, I would highly recommend it.
THE FUTURE? - The CHUMS [Canine Hereditary Urothelial Malignancy Study] is underway at the Baylor College of Medicine in Houston, Texas. Dr. Fred Leach, with an extensive background in cancer research, is collecting blood samples from Scotties affected with bladder cancer, as well as samples from parents, littermates, and offspring with, or without, bladder cancer. From the samples of affected dogs, Dr. Leach has obtained DNA samples and through research may be able to unlock the genetic cause of canine TCC through identification of regions within the dog genome linked to the development of bladder cancer. He will be using specific markers to locate the precise region of DNA containing the putative genetic defect that predisposes Scotties to TCC. We now have five DNA samples stored there. Too little, too late, for our Scots. But maybe, down the line, someday, the tragedy that has befallen us will serve to provide a TCC clear future for others of our beloved breed.
CUPS, Idiopathic Stomatitis, or Contact Mucositis By Any Name, This is Bad News
By Marcia Dawson DVM
Chariman, STCA Health Trust Fund
DVM February 2014 in National Pet Dental Health Month.
This article highlights one of the more serious oral health issues that Scotties may face.
What is CUPS? Chronic Ulcerative Paradental Stomatitis or “CUPS” is a painful and often debilitating disease of the mouth involving the gums, the mucous membranes of the cheek, the lips, the roof of the mouth, and the tongue. These are the “paradental” tissues, not the teeth themselves. Some dogs afflicted with CUPS also have periodontal disease with heavy build-up on the teeth, inflamed, swollen bleeding gums, infection, and bone loss. However, many dogs with CUPS have normal looking teeth with very little periodontal disease present. What we do see in dogs with CUPS are painful ulcers or erosions on the gums, on the membranes of the inside of the cheek, on the roof of the mouth, and even on the tongue.
What causes this disease? Veterinary dental experts are not certain of the exact cause of CUPS, but they do know that the ulcers arise in tissues which come in contact with the teeth, so called “kissing” ulcers. CUPS ulcers may result from an initial injury, but in many cases is there is no known instigating cause. The severity of this disease intensifies due to an overreaction of the dog’s own immune system to the plaque on the tooth’s surface. Plaque is the creamy, smelly substance on the teeth that is formed continuously from food particles, bacteria and debris in the mouth. Over time plaque leads to gingivitis (inflammation of the gums) and hardens into calculus, which adheres tightly to the tooth surface and must be scaled to be removed. Plaque therefore plays a key role in both periodontal disease and CUPS. Furthermore, there is reason to suspect that CUPS has a genetic component in some breeds such as the Maltese, Greyhound and King Charles Spaniel. Unfortunately, CUPS has also been reported in Scotties.
What are the symptoms of CUPS? Some of the more common symptoms include horribly bad breath, excessive drooling with thick, ropy and at times bloody saliva, pain in and around the mouth, and difficulty eating. Obviously other conditions can cause these symptoms, such as oral cancer, injury and abscesses, kidney disease, and other immune mediated diseases, so a trip to the vet is needed for diagnosis
What is the treatment for CUPS? Before a treatment plan can be ordered, a complete oral exam must be performed under anesthesia. Dental x-rays, blood work, and a thorough cleaning of the teeth with examination of the ulcers will be done. Your vet will extract any unhealthy teeth and may even remove some healthy teeth that are in direct contact with severe ulcers. For the remaining teeth, the long-term plan will involve daily teeth brushing, oral rinses, prescribed medications to reduce the pain and inflammation, and a course of antibiotic therapy.
Is there a cure? For dedicated owners willing to stay vigilant and work hard on the plan, there may be some degree of success. But many times, in spite of our best efforts, the pain, ulcers and eating disorders return. It is not easy to stay ahead of microscopic plaque development, and remember that CUPS is an immune mediated disease, making prevention doubly difficult. If there is a relapse, extraction of all the remaining teeth may be needed. This sounds drastic, but CUPS calls for drastic measures! Removing the teeth removes the plaque, which is the source of the exaggerated immune response, the inflammation and the pain. Along with full dental extractions, the alveoli (the holes in the jaw where the teeth used to sit) are curetted and smoothed to ensure that the infection will not extend further into the bones of the skull. Many times the dog will feel better almost immediately and begin eating again. Some former CUPS patients go on to live a regular lifespan after extraction of all the teeth, and they apparently have no difficulty gumming their kibble. The tongue may loll out of the mouth on occasion, but that is small price to pay for a pain-free life.
Is there anything we can do to avoid CUPS? Probably not, in certain individuals. Their genetic course may be already set. To be safe, any dog known to be affected with CUPS should not be used for breeding at any time.
More than 75% of pets 3 years of age and older in the US are already developing some degree of dental disease. So a good plan for all Scotties is to keep the plaque from building up with daily brushing. Starting at a young age, any Scottie will learn to tolerate and even enjoy the daily routine. Use a soft child’s toothbrush and toothpaste formulated for pets that is designed to be swallowed. Concentrate on the outside surfaces of the teeth, both top and bottom. Have your vet examine the teeth closely at each wellness visit and perform a dental cleaning under anesthesia when needed. Let’s keep our Scotties as healthy and long-lived as we possibly can with good dental care!
Too Little, Too Late Redux (TCC)
Published in The Bagpiper 2007, issue 2
Copyrighted By Nancy Aaron
It is 4 a.m. in Morro Bay. David the Bruce, one of our three TCC afflicted Scotties, is snoozing on the couch next to me ... happy and accepting of the predawn skritches he is getting behind his ears. It is a peaceful time for gathering scattered thoughts and putting them to paper. In retrospect, I never thought I would be addressing this topic again. Two years ago, I felt I had said all that I had to say.... but a lot of "kibble has passed through the kennel" since I penned "Too Little, Too Late". Twelve-year- old D?Arcy was put down two years and five months following TCC diagnosis, not from the bladder cancer, but from failure of her single kidney. The problem may have been generated by the piroxicam, or the chemotherapy drug, mitoxantrone, or the combination of the two drugs. Eleven year old David is now being administered fluids to assist his failing renal function, as is nine-year-old Piper, also born with a single kidney. We have concluded that, while it undoubtedly was the drugs employed in treatment of TCC that caused the renal problems, the long range benefits gained from having taken an aggressive approach in fighting the cancer were more than offsetting. And, if we had it all to do over again, we would. In the meantime, we have had a plethora of new, and meaningful, experiences in dealing with the problem. And, for those of you presently involved with the care of TCC Scotties, or those of you who, sadly, may become confronted in the future, this one's for you.
What a dichotomy!
The number one cancer afflicting the Scottish Terrier is transitional cell carcinoma, bladder cancer. Yet, within the general dog population, TCC represents less than 2% of all canine cancers! It is the extreme of these positions that creates one of the most serious problems confronting the Scottie owner. Too many veterinarians are unaware of this critical information and will treat for urinary tract infection. Sadly, due to its invasive nature and the likelihood of metastasis, the need for quick diagnosis and the initiation of immediate treatment can mean the difference between a reasonable extension of life, or a tragically hastened death! To put it bluntly, there is a strong probability that the burden of obtaining an effective diagnosis will be yours, the owner, to enforce a timely finding for probable TCC. In the sixty-seven cases where we have consulted, more than half the Scotties had been initially diagnosed and treated for "chronic" urinary tract infection. Sometimes this had gone on for months, many months, before more telling symptoms manifested, or a bell went off in someone?s head, and the possibility of transitional cell carcinoma became a consideration. I remember well, at the first, and excellently presented, San Francisco club?s Canine Cancer Seminar, meeting Marcia Dawson, DVM, and STCA member, who in the course of her brief talk as moderator, succinctly stated: "If your veterinarian tries to tell you that a TCC symptomatic Scottie has only a urinary tract infection, run, don?t walk, for an ultrasound.... insist that this test be done".
Red Flags - The signs for TCC have always created confusion and now, with Scotties as young as four years of age being diagnosed, we can no longer find comfort with the previously theorized onset age of eight years. And, while ultrasound is becoming increasingly recognized as a valuable diagnostic tool, it can never take the place of the owner?s ability and responsibility to detect early warning signs. With all nine of our TCC dogs, we have never seen blood in the urine. What we did see was a change in the urination patterns. With females, the functional get-it-over-with squat became visibly prolonged. With boys, the leg lift exceeded the customary time. If you observe the Scottie continuing to "try" to urinate, or making a repeated effort with little, or no emission, this is a serious red flag, as is the more obviously seen blood in the urine. Any departure from the norm..... Peeing on the carpet, or any place normally off limits, is a warning. With any of these signs you should consider TCC as a possibility and seek veterinary attention.
Criteria and What to Do Next? - We do not consider ourselves "risk takers" and only settled upon a treatment plan after studying evidentiary research, mostly via computer. Our vets utilized the remarkable resources found on the Veterinary Information Network, VIN, while I researched the supplement portion of our plan by studying bona fide websites. [With 973,000 Google hits for canine bladder cancer, there is a lot of snake oil for sale in Cyberspace!] Before determining any course of action, ultrasound findings must be assessed regarding the tumor, its size and location. Whenever possible, we have always had it surgically removed, multiple times if a tumor returned. The canine bladder is remarkably elastic. Of course, prior to any surgical consideration, both the U/S and blood work must be reviewed to examine renal functions and to check for any metastasis. The general health of the Scottie must be considered as well. Age alone should not be a factor since a number of TCC Scotties 12 years and older have been successfully treated for bladder cancer and have continued to lead joyful lives, some for years post diagnosis.
Chemotherapy - On the basis of efficacy, the combination treatment of mitoxantrone and piroxicam has proven to be the most effective. There is some risk associated with use of either drug, and monitoring is important. Piroxicam can cause gastrointestinal irritation and also harm the kidneys. It should always be administered with food, and accompanied by the use of a GI tract protectorant such as Cytotec. Prior to administration of mitoxantrone, tests for the renal function must be done. During the chemotherapy cycle, the white blood cell count must also be performed. Observation in studies involving large numbers of dogs has shown that the use of a NSAID alone, such as piroxicam, will improve the quality of life, and often serves to relieve straining as well as any pain. To allay any ill- conceived notions regarding chemotherapy, with mitoxantrone use we have seen no behavioral changes, no hair loss, no dietary problems, and no lethargy following treatment. Administering the drug is not complicated. It is done via IV catheter and we have helped steady our Scots during the brief procedure. Our family vet handles the full treatment program, but does not stock the drug and cost can be a factor. For the first application, we had to buy it from our local pharmacy. The cost was $1300 for the 10 ml bottle. This provides more than enough for two cycles of four treatments for a twenty-pound Scottie. We were dealing with four patients and when more was needed, we web located a Canadian supplier and acquired the same drug for $475. We went off the grid when it came to the application of mitox, moving from the first cycle, into second, and third cycles when ultrasound showed tumor return.
Prognosis Factoring - Never having been a "numbers" person, I have always been uncomfortable when a need arises to employ statistics. But, if it seems prudent to drive home a point, I will make the effort. The point in this case being that Median Survival Time findings should be considered in order to evaluate and select a course of treatment for either bladder cancer or prostatic TCC. Isn?t this just plain common sense? And, when a treatment plan has had long-term use, and the results produced have far exceeded projected survival times, then such regimen would certainly seem to merit consideration.
Survival time statistics will vary for different reasons, including the number of dogs involved in the research program. But, by and large, the following is that most frequently used by consulting oncologists.
Combination of mitoxantrone and piroxicam - 1 year [365 days]
Piroxicam only - 6 - 9 mos [180 - 274 days]
No treatment. - 6 mos, or less [183 days]
Successes and Failures - In January 2006, after a series of three consecutive quarterly ultrasounds had shown no signs of cancer reoccurrence, having ceased using mitoxantrone, we also stopped the administration of piroxicam for both Kirsty and Piper keeping only the balance of the regimen in effect. Ultrasounds done in February 2007 remained clear, and we see no clinical signs to indicate a return of the cancer. We will never know why this has happened. We only know something must be working in that many Scotties on the same regimen are having life spans that exceed TCC life expectancy projections. And, in addition to the chemotherapy protocol used, how can we not consider the over-all picture... the contribution of the supplements, the entire treatment program?
As of March 25, 2007, the following records stand:
Piper - 1091 days and counting: Surgeries  - Combined protocol
Kirsty - 753 days and counting: Surgery - Combined protocol
David - 867 days and counting: [prostatic TCC] - Combined protocol
Regarding life expectancy, while treatment chosen can influence outcome, much is governed by a multitude of variables.... not all of which are within our ability to control. However, there have been a number of Scotties whose lives were needlessly foreshortened due to human error.... not just the luck of the draw. I would be remiss if I failed to cite these mistakes, as they are correctible and fall within the owner?s purview to change.
Failure by owner to notice observable clinical signs
Incorrect and/or delayed diagnosis by veterinarian
Failure by owner to advocate on behalf of the Scottie
Reliance upon ultrasound needle aspirate sample for diagnosis
Failure by vet to be aware of currently approved treatment options.
Vet prescribes lethal dose of NSAID piroxicam
No treatment is tried
The Regimen - A Treatment Plan Consisting of Approved Protocols in Combination with Supplemental [not alternative] Additions
Piroxicam [at 0.3 mg/kg SID, used with the gi protectorant Cytotec]
Misoprostol [Brand Name: Cytotec]
Mitoxantrone - [Only if kidneys are healthy on paper and U/S]
Baytril, or like antibiotic, for ten days following chemotherapy
Broccoli, stovetop steamed for 4 minutes - About 1 heaping T daily
Cranberry Capsules [400 mg + or -] - One in a.m., one in p.m.
Apple Cider Vinegar - one tsp sloshed over evening kibble
Make sure that urine is not held for prolonged periods
What Lies Ahead? I have said, now too many times over, how sorry I am that any Scottie owner has to go through this. If there is anything at all good to be said about TCC, it is that it is one of the easier cancers to deal with, for both the owner, and the pet. It is not painful ... and it usually is not as rapid in deadliness as are other cancers. It is treatable and TCC Scotties can lead longer and carefree lives.... sometimes for years post diagnosis. Despite decades of ongoing trials and the continued efforts by many research institutions to find a cure for transitional cell carcinoma that target remains elusive. Of more immediate promise may be those research programs now attempting to identify the underlying causes, the genomic mutations associated with TCC. Until there is a breakthrough, we must cope as best we can with the hand we?ve been dealt.
There is no handbook, no Primer, for doing this. We are sharing our experiences, hoping to provide helpful information for others who may tread this path, making their task a little less daunting. In working with others, there are always a number of questions. The one that has been most constant has been - "How will I know when to make the final decision? I do not want my Scottie to suffer pain". The signs you will see are the signs you saw at onset.... a prolonged effort to urinate, repeated attempts, with lessened emission. At this point the two of you have finally come full circle and the time has come to part.
Jaws Or They Are What They Eat! This, Too, Will Pass or Will It?
Published in The Bagpiper 2007, issue 2
Copyrighted By Nancy Aaron
If I had to describe her, I would have to say any mental image of our eight-year-old Piper would more closely resemble a picture of Dorian Gray than that of a well-bred Scottish Terrier. Through the years she has managed to morph into a somewhat garish montage; one created from ingesting paper clips, ball point pens, terry towels, a plastic floor mat, twisties, a hearing aid, eye glass frames, as well as pure adulterated shit. She is sixteen pounds of Hoover-on-paws. Her latest culinary escapade defies all reason. After a routine visit to the vet, I put her in her pink crate, leaving her Resco lead on her. When we got home, I opened her door, reached in for the lead, fished around for the lead, looked for the lead ...... and all that was there was Piper with a hank of what was left of the lead still in place around her neck! She had consumed all ten feet up to the clasp!
Anyone who owns a Scottie, who claims that the little blighter has yet to eat at least one foreign object, must be either blind as a bat, or uniquely lucky! For most of us, it has become the nature of the beast. With some Scotties being more beastly than most! So - From the experience tomes of the Kaynans -> -> -> ->
SCOTTIE CODE BLUE - Poisons:
It was late at night when a container of people pills fell, scattering over the kitchen floor, to the delight of our two youngest Scotties. The dogs were immediately crated, the pills inventoried, and one dangerous heart pill was missing! We called the Poison Control Hot Line and were told to administer two tablespoons of 3% fresh hydrogen peroxide to induce vomiting, and transport both to the emergency hospital.
With each crated separately, and one of us as observer, we headed out at midnight, taking the pill bottle with us. En route, the less likely of the two vomited up the heart pill. Following a night at the hospital she came home none the worse for wear. We since have learned that the peroxide should be repeated every five minutes, until the item is recovered. A gravy baster, or a syringe, is a must.
[Note: An emetic should never be used when anything caustic, or anything sharp, has been ingested]
THE 3-MONTH UPCHUCK MYSTERY:
It was August; we were three days out on a cross-county road trip with our six Scotties. We'd gone out and returned to the RV to find a thoroughly gnawed vinyl floor mat, with the border chewed off. Pieces were everywhere, including in David. That became apparent when he threw up a small piece that night. A week later, at dawn, he threw up a minute amount of yellowish, frothy gook, and then went on to eat, play, and challenge the world. For two months he was like cotton pickin' alarm clock, retching, the yellow froth, always at dawn, but was never sick. We had had x-rays early on, saw vets in Michigan, New York, Connecticut, and finally, in October, we went to a vet in Virginia who knew what he was doing. The August x-ray had been a single view only. All vets, thereafter, had accepted that one view as a negative-for-foreign-object finding, and ran a barrage of tests for everything else under the sun. The Virginia doctor took two views, one dorsal, one lateral, and there was a small piece of the vinyl floor mat shown lodged against the wall of David's stomach. The next day an internist, using an endoscopic procedure, successfully removed the object.
SCOTTIE CODE BLUE - Dangerous Foreign Objects:
There can be a fine line between things requiring medical attention, and those that are likely to pass without creating a life-threatening problem. If the dog swallows a rock chews apart anything with sharp edges, such as pens, pencils, glasses, toy squeakers, metal objects and you think he/she has ingested sharp pieces, immediately call a veterinarian. Usually x-rays are mandated, and abdominal surgery may be required.
FLOTSAM AND JETSAM:
When ingestion of non-life threatening items, such as twisties, paper, small non-sharp things, bits of cloth, pieces of shoes, and similar "prizes", we immediately feed 3 - 4 slices of moistened bread, with the goal of encapsulating the item for safer passage through the system. This can take several days and you should be on poop patrol for the entire time. I am not going to leave you off the hook on this one! You should examine, not just "look" at, the stool. I scoop it, drop it on a paper towel, cover with another paper towel, and step on it to mash it flat. You can see items you would otherwise miss if encapsulated. Why bother, one might ask? Think: Diamond ring. Think: $1200 hearing aid. Think: The dog is better off with you knowing the outcome? If, during the course of this hoped-for passage, the Scottie starts vomiting, has bloody stools, is constipated, becomes weak, "dens", or loses appetite.... immediately seek veterinary care.
All of this information may be well and good; but also may have been a total waste of time if you missed the snippets that appeared in bold text!
You should never have to look up the emergency number. It should be fingertip!
Code Blue and persistent vomiting: Always talk directly to a veterinarian
Have a First Aid kit always. Include unopened 3% peroxide and a syringe
It is smart to keep at least one crate in the car for emergency transportation
When checking for foreign objects in stomach, at least 2 x-ray views are a must
Keep fresh bread on hand. It can be the little things that count in life