Dr. Tina Wismer (Senior Director of the ASPCA Animal Poison Control Center) and Dr. Andy Roark discuss the recent spike in house plant poisonings in dogs and cats, where this increase is coming from, and what steps doctors and technicians can take on the phone and in the clinic to address it.
LINKS
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ABOUT OUR GUEST
Tina Wismer, DVM, MS, DABVT, DABT, is the Senior Director of the ASPCA Animal Poison Control Center. She earned her undergraduate degree from Ohio’s University of Findlay and received her DVM from Purdue University. Dr. Wismer worked in both small animal and emergency practice before joining the ASPCA Animal Poison Control Center in 1998. Dr. Wismer is a Diplomate of the American Board of Toxicology and the American Board of Veterinary Toxicology. She is an adjunct instructor at the University of Illinois, a visiting professor at St. Matthews University (Grand Cayman), a consultant for VIN (Veterinary Information Network) and a Master Gardener.
Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram
SHOW TRANSCRIPT
Dr. Andy Roark:
Welcome, welcome, welcome to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, today I sit down with my friend, Dr. Tina Wismer, from the ASPCA Poison Control Center, and we talk about the spike in house plant-related toxicity. Why is it happening? How big is the spike? What is it coming from? What are the house plants? What should we say to pet owners? What do we need to know for when these cases walk in the door? Guys, we get into it fast and furious. Just get it done. Give you some pearls that’ll make you smarter on your way to work. Isn’t that what we’re all here for? Guys, let’s get into this episode.
Kelsey Beth Carpenter:
This your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome, Dr. Tina Wismer. Thanks for being back on the podcast.
Dr. Tina Wismer:
Thanks for inviting me.
Dr. Andy Roark:
Always. I always love it. I like to stay up-to-date in my toxins and just be prepared for what might walk in the door, so thanks for being here.
Dr. Tina Wismer:
Thank you.
Dr. Andy Roark:
I wanted to ask you about a trend in medicine over the pandemic. I’ve been reflecting back on the pandemic in the way that life is a little bit different now than it was before. I think it’s a fascinating exercise. House plant toxicosis is a growing trend. We are seeing more pets, dogs and cats, that are coming in after ingesting exotic plants. First of all, let me just ask you, is that true? And how do we know that?
Dr. Tina Wismer:
Yeah, it’s certainly true. Looking at our numbers from 2019 through end of 2020, we had almost 10,000 more plant-related calls in 2020 than we did in 2019, so a huge increase in our number of calls.
Dr. Andy Roark:
Just real quick. I’m assuming that people picked up indoor gardening as a pandemic thing. Is that the theory?
Dr. Tina Wismer:
Certainly. We saw a lot of people who decided that, okay, I can’t go outside. I can’t do things. Let’s bring the outside in.
Dr. Andy Roark:
Well, I live that. I have tomatoes for the first time ever, and my dog is an absolute monster and just eats… I haven’t gotten to eat any of the tomatoes. I haven’t gotten to eat any of these tomatoes. I had a bunch of tomatoes. My dog ate them all. I planted… For some reason, I planted one strawberry plant thinking that it would spread or it would have a lot… It did not. It made exactly one strawberry, and a squirrel ate it. That’s been my entire gardening experience from the pandemic. I am out of home gardening based on this one year. Okay. Indoor plants. What are the most common problem-solving house plants that we’re seeing?
Dr. Tina Wismer:
Right. Probably the biggest popularity during the pandemic was seen in succulents. When we think about succulents, it’s a pretty huge group of plants.
Dr. Andy Roark:
Right.
Dr. Tina Wismer:
But the nice thing about them is they’re really easy to take care of, right? They need a little bit of sun, you water them every few weeks, right. They’re really low maintenance.
Dr. Andy Roark:
Mm-hmm (affirmative).
Dr. Tina Wismer:
Fortunately, they’re also not very toxic.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
When we did have dogs and cats getting into them, you can see some mild stomach upset, but fortunately, that’s about it.
Dr. Andy Roark:
Okay, so lots of concern calls. Do you do anything for those? When you get that phone call and they say, oh, my cat or dog ate a succulent, anything you’re going to do other than just tell them to watch it and let us know if you need supportive GI care?
Dr. Tina Wismer:
Right. We may dilute with a little bit of milk or water if they’re not vomiting yet. Then if they do start vomiting, we’ll have the owners take away food and water for an hour or so. If they continue to vomit through that, then they get to come and see you at the veterinary clinic.
Dr. Andy Roark:
Talk to me a little bit about the dilution with milk or water. What exactly do you say to pet owners? I imagine a gallon of milk and a small cat and just hilarity or horror ensuing.
Dr. Tina Wismer:
Exactly. We do give recommendations for how much to give, and typically it’s a milliliter per pound, so a teaspoon of milk per five pounds of animal.
Dr. Andy Roark:
Is the goal to induce vomiting? I’m assuming that that’s not where we’re going with this. We’re just saying, just give them this amount and… Do they expect something to happen, or do we just tell them, just give it and then just wait and see what goes? Yeah. What are the expectations in the outcomes?
Dr. Tina Wismer:
Sure. With dilution, the expectation is to decrease the irritation to the stomach.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
A lot of these plants, like your succulent plants, may contain… They have white sap, which is irritating and somewhat related to soap compounds.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
If you think about your mother washes your mouth out with soap, you could see some gagging and vomiting, but it’s not expected to be serious. By diluting that out with some milk, we can hopefully stop you from having vomiting.
Dr. Andy Roark:
Great. I found that when my mouth was washed out with soap, adding water just made it worse. It was just more bubbles, more prolonged flavor, but no, I’m with you. Okay, cool. Succulents. Very, very common. Not a big deal. We’re coming out the other side pretty well. Are there more dangerous house plants that we’re seeing increases in?
Dr. Tina Wismer:
Yes. Probably one of the most dangerous house plants are actually these cute little potted sago or cycad palms. These actually can cause liver failure in both dogs and cats. They typically were used outside in the warm areas of the country: Florida, Texas.
Dr. Andy Roark:
Yeah.
Dr. Tina Wismer:
But you can now go to places like IKEA or Home Depot or Lowe’s and buy these little potted sago palms.
Dr. Andy Roark:
When I used to live in Florida, sago palm toxicity was something that we really worried about, and we definitely saw it. Help me understand. A potted sago, is it a miniature version? Is it a tiny thing? Is this a floor sitting plant? Help me get my head around this. I’m not familiar.
Dr. Tina Wismer:
Yeah. Most of these are actually the miniature versions. They typically sell them in a four to six inch pot, and they stand about eight to 12 inches tall.
Dr. Andy Roark:
Okay, so tiny. Yeah.
Dr. Tina Wismer:
Yeah. They’re not as toxic as the ones that grow outside, because the ones that grow outside, the most toxic part is the nut, or the fruit, that they make.
Dr. Andy Roark:
Right.
Dr. Tina Wismer:
These, of course, don’t mature enough to reach that point, nor do they have one of each sex to make the fruit.
Dr. Andy Roark:
Mm-hmm (affirmative).
Dr. Tina Wismer:
They certainly can still cause liver problems, but we don’t see the severe death that we see with the versions that are outside.
Dr. Andy Roark:
We’re mostly seeing pets eating the leaves, picking up the whole thing like a big chew toy, mouthing of the plant. Okay.
Dr. Tina Wismer:
Yeah.
Dr. Andy Roark:
Not super severe. What type of clinical presentation is this going to have? Again, I’m familiar with the sago palm, the big outdoor… I was always afraid of… The fruit is really the scary part for me. When the pet owner calls me, what are they going to tell me they’re seeing?
Dr. Tina Wismer:
Sure. We could see vomiting, sometimes with blood. If it’s been going on for a day or two, they may have decreased appetite. They may be anorexic. As we said, potentially bloody vomiting. Lethargy, so they need to come in and see you.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
When you check their blood work, they’ve got issues with their liver.
Dr. Andy Roark:
All right. General maintenance on is just going to be supportive liver care, lots of fluids, hospitalization.
Dr. Tina Wismer:
Yep. Fluids, monitor our liver values, liver protectants, and time.
Dr. Andy Roark:
Walk me through the use of liver protectants in case like this. What expectations you set for the pet owners?
Dr. Tina Wismer:
Sure. With sago palms, we typically use a combination product that includes both SAM-e and denamarin.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
Excuse me, SAM-e and milk thistle, so denamarin is the common trade name. What that helps with is to provide glutathione.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
That helps the liver heal, and it also helps reduce the reactive oxygen species that occur when we have liver damage.
Dr. Andy Roark:
Okay. About how long do you usually tell people that they’re going to be on these medications?
Dr. Tina Wismer:
Most of these guys are hospitalized for two to three days, and then we send them home on the medication for usually a couple of weeks.
Dr. Andy Roark:
A couple of weeks. Okay, and then just continue to monitor liver values and then take them off when you’re back to normal. Okay.
Dr. Andy Roark:
Gang, I just want to jump in here real fast with a couple quick announcements. Over at the Uncharted Veterinary Podcast, Stephanie Goss and I are talking about letting go of the guilt. We’ve got a question from the mail bag for a young doctor who needs some things to change in her practice. She’s asked about them changing and she’s asked that they change, and she’s not seeing anything. She’s feeling like this is not what she was promised, but she’s really struggling with guilt about just being like, hey, I’m out of here. How do you process through that? How do you know when it’s time to leave? How do you know when it’s time to push harder to get what you need?
Dr. Andy Roark:
We break that down so you can get that wherever you get podcasts. Unchartered Veterinary Podcast. It’s coming out this week. Over on the Uncharted Learning side of the house, we have workshop this Saturday, so two days from the day this podcast comes out. Empowering your team to get positive and stay that way, that’s October the ninth. It is a two-hour workshop is with the amazing Dr. Tracy Sands. I’ll put links down below, but buddy, you better get on that fast, because it is going to close. But if it closes and you’re like, ah, I didn’t make it, hey, don’t worry. It’s not the end of the world. We have the Uncharted Culture Conference. It’s October 21st through the 23rd. It is full-day virtual conference. It is all about getting a beautiful, wonderful, happy, healthy place to work. If your team is all about culture and you’re like, Andy, we have a wonderful place to work, I’m going to say, I’m just saying to you, we can go to the next level, because this is all about culture and the people who are going to be there are not people who generally have toxic cultures.
Dr. Andy Roark:
They’re going to be people who recognize the value in culture and love culture and love learning about culture. If you’re already rocking and rolling, hey, we still have good stuff for you. That’s going to be it for about now. As I said, I’m just going to let you guys go with that. I hope to see you at some of these events, and I will talk to you soon.
Dr. Andy Roark:
So far, the succulents. I totally saw succulents coming. Did not see potted palms coming.
Dr. Tina Wismer:
Potted palms.
Dr. Andy Roark:
Anything else?
Dr. Tina Wismer:
The other thing that we noticed during the pandemic is because we couldn’t get together, right, I couldn’t go to mom’s house for her birthday, I would send her a bouquet.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
So unfortunately, that meant we saw a lot of cats getting into lilies.
Dr. Andy Roark:
Okay, yeah. That makes a lot of sense. Can you review lily toxicity in cats? I know this is a classic. I think it’s always good to get a brush-up on what are we looking for, what are the presenting complaints, then what are going to be our staples of therapy.
Dr. Tina Wismer:
Sure. When we think about lilies and cats, they’re highly toxic. Even cats that just have pollen on them, they’re going to groom themselves off and become exposed and have kidney failure. Also, if they eat leaves or if they eat parts of the petal, they can get kidney failure. Typically, after exposure, within about two to six hours, they start to vomit. Then they become lethargic. You may notice an increased thirst and urination. However, as the days go by, they stop producing urine. They become anuric, and they die.
Dr. Tina Wismer:
Timeframe wise, we start to see our kidney values going up between about 12 to 18 hours post-ingestion.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
18 hours is this magic number. If we start to treat them in the first 18 hours, we have a good prognosis. If it’s after 18 hours, our prognosis goes down.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
Treatment. Most important part is fluids.
Dr. Andy Roark:
Mm-hmm (affirmative).
Dr. Tina Wismer:
We don’t know what the toxin is, but we know that it causes death of the renal tubular cells, and then this debris plugs up the tubules. It’s important that we keep up urine flow by using IV fluids.
Dr. Andy Roark:
OK. That totally makes sense. Can you… Talk to me a little bit about the 18 hours versus clinical signs. The hardest cases for me with toxins are when the pet is not yet showing symptoms and I’m trying to convince the owner, no, this is serious. And they go, no, look at her, she looks great. And I’m like, no, you’re not hearing me. This is going to be a problem. Yeah. When we look at this, at 18 hours, am I seeing clinical signs in the pet? Are we having vomiting? I know it’s a progressive condition. Yeah. Talk to me a little about that.
Dr. Tina Wismer:
Yeah. In that first 18 hours, we’ve usually started to vomit by then, and we may also be showing some increased thirst and urination.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
And lethargy. Yeah, it’s all about telling owners, okay, this is what we expect. This is what we need to prevent. Especially with lilies, I always tell them we don’t do kidney transplants in cats.
Dr. Andy Roark:
Yeah.
Dr. Tina Wismer:
At least not on a regular basis. We need to prevent it, otherwise, we may end up with a dead kitty.
Dr. Andy Roark:
Yeah. How do you quantify the plant toxins? Or do you even try? Do you just say when the pet owner comes in and they’re not showing any clinical signs and they’re like, oh, we have lilies on our table and I know that that’s bad, and I looked over and her nose was touching it, and maybe she ate a petal or maybe it just didn’t have a petal right there in that specific spot. I don’t know. Yeah. Do you even have those thoughts or are you just like, hey, look. It’s close enough that your cat’s going to spend the next 18 hours here on fluids and we’ll be checking renal values.
Dr. Tina Wismer:
Yes. Lilies are certainly that toxic that I would prophylactically start them on fluids before they show problems.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
Some of our other plants, we may wait until they show clinical signs, but lilies are not one of them. If there is a cat in the house and a lily in the house, I would treat them.
Dr. Andy Roark:
Okay, so lilies are a broad category, of course.
Dr. Tina Wismer:
Yeah.
Dr. Andy Roark:
I tend to think specifically… I, for whatever reason, white lilies are in my mind, are you just across the board lilies, tiger lilies, any type of lily that you would get from the florist, that’s a straight trip to the IV fluid line?
Dr. Tina Wismer:
That is a great comment. Lily, common name for lot of different flowers.
Dr. Andy Roark:
Right.
Dr. Tina Wismer:
We are talking about members of the Lilium family, so it is. It’s tiger lily, Easter lily, those beautiful stargazer lilies that they use in bouquets, they’re the pink with the little dots in them, all of Asiatic and Oriental lilies are Lilium and are problematic.
Dr. Andy Roark:
No, that’s good to know. Yeah. I’d always assumed a lot of the Asian lilies were problematic. That’s just not the generic lily that’s in my mind, so that’s good to know.
Dr. Tina Wismer:
Let’s just say, if you’re thinking about something like peace lily or calla lily, those are considered to be toxic plants, but they’re not kidney toxic in cats. It has to be a Lilium.
Dr. Andy Roark:
Okay. Are there any mistakes that you see general practitioners making with some of these toxins? If there was one thing you would say, look out for this, or this is a mistake that I see doctors make sometimes, what would you point to?
Dr. Tina Wismer:
Right. I think part of the issue is we have owners that look online or we look online and see, hey, this plant is toxic.
Dr. Andy Roark:
Mm-hmm (affirmative).
Dr. Tina Wismer:
With dogs and cats, many times with toxic plants, they don’t eat enough to cause problems.
Dr. Andy Roark:
Right.
Dr. Tina Wismer:
Unlike grazing animals. Horses, cattle, they can certainly get themselves into severe trouble. We probably see animals being over-treated when they don’t need to be. We know that inducing vomiting or giving a dose of activated charcoal, it can have adverse effects. It’s not benign therapy.
Dr. Andy Roark:
Okay. I want to unpack that a little bit because that’s really interesting me. That’s always been something I have looked at. I have wrestled with, the hey, I just want to get this checked out or just calling, nothing’s happening, but I did notice this. I am always wary of being a bit chicken little-ish of you have to come in and get this done and then nothing happens and the pet shows no clinical signs at any time, and the pet…
Dr. Tina Wismer:
Mm-hmm (affirmative).
Dr. Andy Roark:
I always feel like that’s a strain on the trust in our relationship with the pet owner. At the same time, I also do not want to regret not being aggressive enough. I really do feel pinched sometimes between not wanting to, not blowing this off, and also not going overboard to the point that the pet owner looks sideways at me, like do we really need to do this? Yeah. Can you help me with that? Are there general guidelines or thoughts that you have when you’re in practice that help guide you in that situation?
Dr. Tina Wismer:
Right. I would say that it’s going to depend. We’re talking about plants, right? It’s going to depend upon what type of plant. If it’s a sago palm or if it’s a lily in a cat, you probably can’t over-treat them.
Dr. Andy Roark:
Okay.
Dr. Tina Wismer:
But with our others, a lot of times, things like rhododendrons and azaleas… If you look in the tox books, it talks about severe cardiac signs and death.
Dr. Andy Roark:
Yeah.
Dr. Tina Wismer:
Dogs and cats, typically, they just have mild stomach upset because they don’t eat enough to be a problem. In those cases, what I usually recommend is for the owner, if they’re going to be home, to watch them. You’re going to watch them for four to six hours. If there’s any vomiting, then we’re going to go see the veterinarian, because we’re going to see vomiting before we see any of the cardiac signs.
Dr. Andy Roark:
Yeah. I love that, and I love that example, rhododendrons and azaleas. That’s exactly what I was talking about, from South Carolina… I’ve always lived and practiced on the East Coast, and there’s a whole lot of people that have azaleas as the fixture focal point of their landscaping. For one week out of the year, their house looks amazing because of its beautiful azalea… And then it’s just green plant. They’re super, super common, and the number of times that an anxious pet owner is… Generally the hyper-aware pet owner, this is their first dog, you know what I mean?
Dr. Andy Roark:
And they’re like, I looked… He was chewing on a branch outside and I looked it up and it said azalea branch, and now I’m very worried. When you look at it, it looks really severe. And I go, I have never seen a pet blow up from azalea or rhododendron, and I’ve always been around them, and I’ve seen those goofy dogs carry those branches around with… I just have never seen it go sideways, and so I’ve always wondered about exactly that.
Dr. Tina Wismer:
Yeah. Dogs and cats, not a big problem, but if you’re one of these people that has goats or horses or cattle, sheep, it’s definitely a problem.
Dr. Andy Roark:
Tina, thank you so much for being here. I really appreciate your time. Where can people learn more about you? How can they interface with the ASPCA?
Dr. Tina Wismer:
Sure, aspca.org, and we actually have a nice plant list of both toxic and non-toxic plants divided by toxic for dogs, toxic for cats, and toxic for horses.
Dr. Andy Roark:
That’s awesome. Thanks so much.
Dr. Tina Wismer:
You’re welcome.
Dr. Andy Roark:
And that is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. I like these “how do you treat that” episodes. I think they’re really useful. I think they make me a better doctor. I hope that they make you guys better doctors and technicians. If there are topics you wish that I would cover, shoot me an email. The email address is podcast@drandyroark.com. That’s podcast@drandyroark.com, and I will talk to you guys next week.
