By Judy Puddifoot, MRCVS
“Give one and a half tablets twice daily for 2 weeks”
I’ve lost count of the number of times I have said this to my clients across my consult room table and simply moved on to see my next patient, thinking no more of it.
Well, the boot was recently on the other foot, and I can tell you it was very uncomfortable!
I adopted a beautiful 11-year-old black Labrador in late January 2018 from the animal charity the RSPCA here in the U.K. This was entirely the “fault” of a veterinary nurse I was working with at the time, who showed me a post on an RSPCA social media page showing a delightful looking older Labrador whose owner had recently passed away. The vet nurse was a little apprehensive showing me the post, as I had lost my previous black Lab just a year before. But she knew I was a sucker for a sob story, especially one in the shape of a black Lab!
The foster carers went to collect said black Labrador on a rainy Friday afternoon in January 2018. I visited her the Sunday of that same weekend and the rest, as they say, is history. By 4 p.m. the following Wednesday (my next day off), Jax was sprawled out and snoring on my lounge carpet as if she had always been there.
As a vet, when I had gone to first visit Jax I had naturally conducted a bit of a physical exam on her in the foster carers’ kitchen — you can take the vet out of the consult room and all that! Anyway, I had found that she had a rather large mass on her lateral left thigh. A sample I had taken on her first day with me (along with full bloods, just to check) had come back saying the mass was a malignant mast cell tumour. A colleague and I removed the rather nasty mass just two weeks after Jax had come home with me, along with removing a couple of other smaller lumps and doing a quick scale and polish of her teeth to improve some rather smelly oral hygiene issues.
Her recovery from the four-hour anaesthetic had been more challenging than expected. Closure of her skin after the tumour was removed had been tight, and some tension-relieving incisions had had to be made on either side of the wound, as you can see in the photo above. This meant recovery was a little longer than would normally be expected. Jax had had to take some medications after the procedure, but she took these in her food like a trooper. Jax made a full recovery from her surgery and had been relatively healthy, until about a month ago.
One Saturday morning last month I came downstairs to find Jax was not waiting at the bottom of the stairs, hopping from one front foot to the other, puffing with excitement because Mum had amazingly appeared again after a long night. (I hasten to add that Jax is free to come upstairs whenever she wishes, but she has a peripheral neuropathy which means her hindlimbs are not as strong as they once were so she doesn’t often climb the stairs.) Instead she was positioned in lateral recumbency on the hall floor. I lay down beside her but did not get the usual response of a tongue in my face and a raised foot in my eye; instead she just lay there looking very dejected. I offered her some breakfast, which she swiftly declined with a nose dodge of the bowl. Now I really started to worry! Jax not eating meant this was potentially serious. She is a Labrador after all!
I took her into the practice and took blood for a full panel – all her results were normal except a mild elevation in her white blood cells. On examining her physically, I found she had a mild increase in her temperature. This suggested a possible infection, so I gave her some opioid pain relief and an injection of a broad-spectrum antibiotic, and dispensed a further six days’ worth of oral antibiotic tablets to be going on with. We went home and I lay on the floor worrying with her all day. She continued to just lie on the floor and had no energy or inclination to do anything. By Sunday morning she had only eaten a tiny amount of food and hadn’t really drunk any water at all. I decided to take her to the practice again, and I hooked her up to intravenous fluids for the rest of the day, hoping this would restore some energy and perk her up enough to start eating again. I gave her a second injection of the antibiotic as she had not been eating so had not had any tablets. Jax’s mobility had also declined even more over the past two days; whether this was due to a natural progression of her peripheral neuropathy or due to weakness or pain, I didn’t know.
Luckily I was on the late shift on Monday, and so I had the morning free. I rang the excellent local referral hospital and they saw us at 10:30 a.m. Jax was admitted and had X-rays and ultrasounds, and was diagnosed with multiple abscesses in her liver! She was discharged with instructions to give her two different antibiotics twice daily for a minimum of six weeks. This, on top of the paracetamol and meloxicam liquid she was already on for her osteoarthritic pain and a tablet for urinary sphincter mechanism insufficiency, meant a total of four and a quarter tablets every morning, followed by three and a quarter every evening. No problem, I thought, she’s a Labrador. What could possibly go wrong? How wrong I was!
This is when the “fun” started. Jax refused to eat anything of substance for the first five days after I brought her home. She was due for her next dose of meds the very night she came home. I placed a bowl of tinned dog food down with her tablets mixed up with the meat. She simply sniffed the bowl and barely managed to hobble into the hall to lie down under a warm radiator, where she stayed until I lifted her onto all fours and used a towel under her belly as a sling to walk her outside to eliminate before bed. This scenario became very familiar as it continued over the next few days.
Over the following week I tried what felt like every single food source on the planet to hide her meds inside. First I tried the staple of fresh-boiled chicken breast. I squeezed half of a tablet between two small pieces of still-warm chicken and she ate it. Great, I thought. This will be easy! I made a second chicken/tablet parcel, and she took it into her mouth but immediately spat it out again. No bother, I thought. I made a fresh chicken/tablet combo and this time offered her a piece of “uncontaminated” chicken first. She sniffed it and walked away.
Next up was EasyPill, a product specifically designed to be very smelly and moldable around tablets – again she took an uncontaminated piece fine, but then spat out the piece with half a tablet inside. I noticed that it seemed to be as soon as she bit the tablet and it became bitter that she spat it out.
Next was Tasty Liver Paste, a dog treat my colleagues suggested, as we sold it at work and many clients had given positive feedback. This worked for approximately four doses of tablets, but then Jax started to become sensitised to the paste; she would not take it from my hand, and she would walk away from a bowl of food once she had smelt liver paste in it. Oh no!
What next? I thought I would try something a little sticky that might stick to her tongue or the roof of her mouth so she would be less likely to spit it out. Cheese spread! This worked for all of two doses until she also got wise to this.
At this point I turned to Twitter for suggestions, and the hive of animal lovers gave me lots of them! Small bread balls covered in gravy worked well, once, as did salmon-flavoured sandwich paste, again, just the once. I discovered Jax is like me and does not like peanut butter, and that she would not eat anything remotely crunchy! Even dry dog food was now off the menu.
I had started to feed her bits of tinned dog food or, to be honest, anything from my plate to try and entice her to eat something. Sausages? What dog can refuse a sausage? Success! She liked sausage and I managed to hide her tablets inside pieces of sausage I put in her bowl with boiled chicken breast. She seemed to like this….until she didn’t.
I was becoming acutely aware that we were entering a vicious cycle. If Jax didn’t take her meds regularly, she would not start to feel better; if she didn’t feel better, she would not start to eat properly, prolonging her recovery. If she didn’t start to feel better, she wouldn’t eat properly. And so it went. It was frustrating, to say the least. I had at points become a little resentful toward Jax and was willing her to please just take the damned pills! I am ashamed to admit that on one occasion I did resort to manually putting the pills down her throat. I winced and apologised to Jax whilst she was backing away from me, my hands prising her unwilling mouth open, and then hated myself so much for doing it that I vowed never to do it again.
Forcing your dog to take medications in this manner is less than ideal on many levels. Some medications can cause oesophagitis or swelling of the oesophagus and so are best swallowed and not left to possibly sit in the throat. The risk of putting meds down the windpipe and not the oesophagus is also ever-present, not to mention the harm forcing your pet to take medications can cause to your relationship and bond with them. Jax had already started to walk or even run away from me when I approached her with food pieces in my hands, even before I had tried to give them to her manually! I cannot tell you how sad this made me, because Jax and I have the closest relationship possible. The excitement we feel and display when we meet after only even five minutes apart is mutual! I did not want to damage or lose that, and I did not want her to start to associate me with anything remotely negative, but desperation can make even the most well-intentioned grasp at straws. I sat on the kitchen floor one evening, close to tears with the frustration and fear that she would not get better because I had failed her not only as an owner but as a vet! My words to owners to simply give the tablets twice daily came back to haunt me at this point, and I had a pang of empathy for each and every one of them and their five-day or two-week struggles to medicate their sick pets.
Two weeks after she had been discharged, Jax had stopped eating anything that was not chicken or sausage, and she was still not willingly taking her tablets. I was at my wits’ end. I could see she had lost weight and she was not the happy-go-lucky dog I knew and loved. Out of sheer desperation I almost resorted to getting a second dog just to see if a bit of competition around food would make her eat!
A couple of people on Twitter had mentioned a product called Pill Pockets, so I ordered some for next-day delivery. I molded the smallest amount of pill pocket as humanly possible around the halved tablets. Jax had started to actually ask for food (chicken and sausage) at varying times each day by now, and so I had started to feed her only small amounts when she asked so as to ensure she would be hungry at medication times every morning and evening. This seemed to work, and so I am still to this day, three weeks post diagnosis and only halfway through her medication period, making small balls of pill pockets and trying to hide them in chicken and sausage meals twice daily. She will occasionally venture to eat a mouthful of dry dog food or a tin of novel dog food he hasn’t tried previously, but she’s not keen! I fear I may have turned a Labrador into a picky eater!
I’m not sure whether it was the Pill Pockets that were the solution in the end or simply that Jax had gotten a fairly decent appetite back and was more willing to eat “foreign” things mixed in with her meal. I am just grateful she started to take those damned pills and that nearly four weeks into her six-plus week course of antibiotics she appears to have finally turned a corner. I no longer have to spend two hours at either end of the day pulling my hair out thinking of new ways to dupe her into taking her meds!
In total I tried to get Jax to take her tablets inside or with:
• Liver Paste
• Fish paste
• Cheese spread
• Chocolate spread
• Peanut butter
• Pill Pockets
Things that were/are next on my “to try” list include honey, gelatin capsules, paté, ice cream, baby food, candy bar pieces, crushing and mixing with water in a syringe or mixing onto gravy, and Kong puppy paste. But none of these are ideal, obviously.
A month on from her diagnosis, Jax is once again rolling around on the floor wanting to play, and yesterday she went for her first wander around the park in the sunshine in nearly a month! And her mum/owner/vet is no longer having to double up on her own blood pressure medication!
I hope that by sharing my experiences of trying to get Jax to take her medications and struggling, even as a vet, has helped other pet owners understand they are not alone in this struggle and that there is no “silver bullet” or magic answer for getting medications into our pets. When they are sick and lose their appetite, it can seem like an impossible task! Again, I am not a proponent of just “shoving it down”; this may be more acceptable for the occasional large worming tablet, but not for twice-daily dosing for weeks on end. It is, in my opinion, unnecessary and one of the quickest ways to ruin the bond between you and your loyal canine.
As frustrating as it can be, I just bear in mind the words of a colleague I was talking to when exasperated by all this, who said, “Don’t give up on her.” There was never any doubt I would give up on her, but I’ll tell you this: It nearly broke me! Good job I love that dog!
Judy Puddifoot, MRCVS, has been a first opinion small animal vet for nearly 6 years. She has a passion for animal welfare and dog behaviour. She has a soft spot for Labradors and currently shares her life with Jax, a 13-year-old black Labrador. She can be found on Twitter and Instagram @judythevet