Episode 21 – When Curiosity Becomes an Emergency: Understanding GI Foreign Bodies in Pets with Dr. Alicia Sorum

Every pet owner knows the feeling: you turn your back for two minutes, and suddenly your dog has swallowed a sock, or your cat has taken an interest in a hair tie that’s now nowhere to be found. Gastrointestinal foreign bodies are one of the most common reasons pets end up in emergency surgery, and they can affect any animal, at any age, regardless of breed or background. From socks and toys to bones, string, and things you’d never expect, these obstructions can escalate quickly to a critical, time-sensitive crisis.

In today’s episode, we sit down with Partner’s emergency veterinarian, Dr. Alicia Sorum to unpack everything pet owners need to know about GI obstructions, including how they happen, how to spot the warning signs, what the diagnostic and treatment process actually looks like, and most importantly, how to protect your pets before an emergency ever begins.

Whether you’re a first-time pet owner or you’ve been through this before, this conversation will give you the knowledge to act fast and advocate for your pet when it matters most.

[Music]

Narrator:

Welcome back to Did You Know?, a podcast by Partner Veterinary. In this series, we dive into everything veterinary medicine and everything Partner. In each episode, we tackle some of the most common questions we hear — from HR to emergencies and everything in between. If it happens at Partner, we’ll talk about it.

Every pet owner knows the feeling. You turn your back for two minutes, and suddenly your dog has swallowed a sock—or your favorite hair tie is nowhere to be found.

GI foreign bodies are a common veterinary emergency, and what starts as simple curiosity can quickly become a serious, time-sensitive problem.

In this episode, Partner Emergency Veterinarian Dr. Alicia Sorum explains what happens when a pet swallows something they shouldn’t. We’ll talk about the warning signs of an obstruction, how these cases are diagnosed and treated, when surgery may be necessary, and what pet owners can do to prevent an emergency in the first place.

Because when your pet eats something they shouldn’t, knowing what to watch for and when to act can make all the difference.

Dr. Alicia Sorum:

My name is Dr. Alicia Sorum. I’m one of the ER associate veterinarians, mostly working ER overnights on the weekends.

I actually started off my career as an equine veterinarian, specifically working with Thoroughbred racehorses. My husband and I met in veterinary school the very first weekend, and then formed an equine practice together, which he still does.

He still does racehorses. I ended up getting away from horses, honestly, mostly because of having young kids. I needed something with more consistent hours and a salaried income.

So, I started doing relief shifts at a local ER northeast of Baltimore, Maryland. I really enjoyed it and fell in love with ER, which was something I never thought I was going to do in veterinary school. But I really fell in love with ER, and specifically ER surgery.

So, I made the decision to leave the Baltimore area and move down to Richmond. We wanted to be closer to family. My sister lives down here, and I just happened to be driving around when I came across Partner by luck.

I drove into the parking lot, walked in, introduced myself, and was offered a job a couple of months later. So, it’s worked out really amazingly.

The level of care at Partner is something I’ve never experienced. It’s really incredible getting to work with the specialists, surgeons, criticalists, internists, and everyone else. It’s been amazing.

Jen Mellace:

Thank you so much, Dr. Sorum, for taking the time to chat with me today.

Dr. Sorum:

Sure. Happy to be here

Jen Mellace:

Today we’re going to talk about foreign body obstructions. They are more common than a lot of people might think, so I wanted to talk about that and find out all the things we need to know as pet owners.

Can you start by explaining what a gastrointestinal foreign body is and how common the problem is?

Dr. Sorum:

Sure. A GI foreign body—or a foreign body in general—is anything that’s in a place where it’s not supposed to be.

Foreign bodies can be in the subcutaneous tissue or in the skin, but most commonly in pets, they’re in the intestinal tract.

Food or medications are supposed to be there. Things like socks and corn cobs are not.

Unfortunately, pets chew things. And this is dogs and cats. It’s just something that they do.

I’d say, without a doubt, the number one presenting complaint of pets coming into the ER is going to be vomiting and diarrhea. These are very generalized symptoms of a million possible different issues.

Foreign body ingestion is going to be something that’s very common, but it doesn’t always necessarily mean that it’s a problem.

Just because they swallow something doesn’t always mean that they’re going to end up needing to be hospitalized or even necessarily seen for it.

A vomiting pet, though, is always going to be something that’s recommended to be seen.

If you call the ER or your veterinarian and say, “My pet is vomiting,” they’re always going to recommend that you come in to be seen.

We hear certain things from owners all the time. Number one for me is usually, “My pet chews things up all the time, but he never swallows them.”

All it takes is one time of swallowing something. Just because your pet chews on socks but never swallows them doesn’t mean it’s not possible.

Jen Mellace:

Like you said, it only takes that one time.

We’ll get into more of the specifics, but I’m curious: What are some of the most unusual or surprising things that you’ve seen pets ingest? And are certain items more dangerous than others?

Dr. Sorum:

Yes, absolutely.

There are a lot of discussions about this on different veterinary Facebook pages, and we love to post pictures of X-rays and pictures of what we found. I think it’s the funnest part of the whole thing.

It’s not fun for the pet, but it’s fun to look at radiographs and kind of guess what you’re going to find.

Things like rubber duckies have a very specific appearance. So do corn cobs, rocks, and socks. They look a very specific way on X-ray.

But you never know what you’re going to find until you get in there.

I had a nurse who was working long shifts overnight, and she always wore compression socks to work. I had her young Golden Retriever come in, and he had what appeared to be multiple foreign bodies.

When I got in there, I was able to remove a compression sock that literally went from his stomach and all throughout the entirety of the small intestine. His whole intestine was compression sock because I think the compression sock was about three feet long.

And bless her heart, she was wearing them to keep herself and her legs healthy, but her dog swallowed one.

It ended up being okay for him because we got it all out in one piece. You hear “compression sock,” but you forget that they are long and stretchy.

Jen Mellace:

How do pet owners typically discover that their animal has swallowed something they shouldn’t have? And what are the common warning signs that would prompt an immediate call or visit to the ER?

Dr. Sorum:

Unless an owner witnesses something being swallowed or they walk in to find the shredded evidence of it everywhere, most owners first notice vomiting.

Anything that is foreign and is not supposed to be in the bowels causes a massive amount of inflammation as it’s swallowed and gets into the stomach. So, it’s always going to cause irritation and vomiting first.

People do call the ER often because their dog is having fairly profuse diarrhea.

Diarrhea can be concerning, but it does show that things are at least moving from the stomach to the other end. So, diarrhea is not going to be an immediately concerning symptom. It can be, but vomiting is going to be the first thing.

A pet that is eating and immediately vomiting, drinking and immediately vomiting, or a pet that cannot hold down food or water is absolutely a reason for concern, and it warrants a trip to the veterinarian.

Jen Mellace:

All right. And I was thinking, as far as diarrhea or bowel movements, if it’s an obstruction, typically they would not be able to pass anything with a complete obstruction.

Dr. Sorum:

With a complete obstruction, anything that’s past that point will continue to move through, and it’ll be diarrhea because everything is very inflamed.

But if they stop having bowel movements and they’re vomiting, that indicates a complete obstruction. That’s concerning.

Jen Mellace:

Please walk us through the diagnostic process. What imaging techniques do you use to identify foreign bodies, and what are you looking for that indicates an obstruction versus something else?

Dr. Sorum:

Your first step is, of course, always going to be a very thorough physical exam, which, as you know, in an emergency hospital is part of the triage process.

The pet is evaluated by a technician coming in. We can look at it, and we call it either regular triage, urgent triage, or STAT triage, kind of based on the clinical picture of the pet.

Then we’re going to do your TPR—temperature, pulse, and respiration. Certain parameters from that part of the triage process are going to indicate how sick the pet is.

Then they’re going to bring that pet back to us in the triage area, or at your regular veterinarian, and you’re going to do a thorough exam.

You’re going to start off by looking at the pet and how it’s acting. You’re going to look at its gum color.

The gum color is going to be either nice and bright, pink, shiny, and moist, or they’re going to be very tacky. They could be injected, meaning that they’re very red. They could be pale white.

That’s all going to be different variations of the septic and sickness process.

Dehydration is always indicated by tacky gums, so we’re going to look at that.

Has this been going on for a while? Is this pet dehydrated?

Usually, their heart rates are elevated because they’re painful. Abdominal and intestinal obstructions are very painful, so their heart rate might be high.

They also might have a low-grade fever. Temperatures in pets vary a little bit from ours. A dog’s normal temperature, especially if they’re excited coming into the vet, can very easily be 102 or 102.5 degrees. But if it’s 103 or 104, that’s a fever.

Cats run a little bit higher than that. Cats can be febrile at 104.5 and up, and they can get up to 107 sometimes.

When you’re feeling over the abdominal cavity, you can also palpate the obstruction. A dog is going to be very painful and splinting its abdomen if it has an abdominal obstruction, and cats can be as well.

Then we always discuss all of this, get the history from the owner, and then move forward into diagnostics.

Diagnostics is something that we don’t go into until we’ve discussed an estimate with the owner and made a plan for diagnostics, because we have to make sure that everybody’s on the same page.

Going forward into radiographs and blood work, it’s hard to separate those two things, especially when you’re talking about foreign bodies.

If you do just radiographs and hold off on blood work, or just blood work and hold off on radiographs, I’m always willing to kind of work with that, but they work better together.

A radiograph is going to be a single, two-dimensional snapshot of the abdomen. It’s very, very helpful and probably the mainstay of diagnostics for foreign bodies.

It’s going to help us determine if there’s things like bone, if the dog swallowed a rock, or if it’s something that’s really, really obvious.

And then, of course, we’re separating that from things like gastric dilatation-volvulus, or GDV.

A dog that comes in retching, gagging, or trying to vomit may have a GDV, and that is a totally different surgery.

GDV is an emergency where minutes count. A lot of people know about GDV. They’ve heard about it. They know it’s called bloat, and they know that it’s an emergency.

That can be something where X-rays are done first. It’s like, “Do not pass Go, do not collect $200.” You go straight to X-ray to determine that.

There are things that we look at to determine whether that’s a concern.

Those X-rays are a baseline for potential obstruction and ruling out very dangerous conditions.

Then, with blood work, we’re going to look at parameters on a CBC, or complete blood count. It’s going to show us inflammation.

We’re looking at elevations in white blood cells. What type of white blood cells are elevated? How concentrated is the blood, or how little fluid is there? How dehydrated is this pet?

That shows us how long this has been going on.

Does the dog also have elevations in the renal values? Are there elevations in the liver values? Are the pancreatic enzymes elevated?

That all indicates a clinical picture of something that’s been going on a little bit longer.

It also tells us about comorbidities. For example, issues with cats that are maybe in renal failure and now they’re horribly dehydrated. They’re really struggling because their kidneys are struggling.

Dogs with Cushing’s disease naturally have very voracious appetites because it’s like they’re always on steroids, and they are the dogs that are going to eat things that they shouldn’t because they’re hungry all the time.

The beginnings of sepsis are also going to be shown on blood work.

So, if your dog has inflammation, it’s concerning for a possible foreign body. We’re going to recommend blood work, and we’re probably going to repeat it a couple of times during hospitalization to determine whether or not this is getting better or worse with what we’re doing.

Jen Mellace:

How does chemotherapy in pets compare to humans?

Dr. Sorum:

That’s one of the big differences—humans are often immunosuppressed during chemo; pets usually aren’t. People get pushed harder, see more drugs, and have much higher risk for infection. The medical term for a drop in white blood cell count leading to infection is “chemo sepsis”—it’s really common in human medicine. In our patients, the risk is usually less than 1%, likely because we don’t push them as hard.

After the initial diagnostics are done, we’re going to go over the results and then we’re going to make a plan.

Diagnostics are well and good, but what are we going to do with this information? We have to look at what we’re going to treat.

We’re taking those diagnostics, looking at the clinical picture of the dog, and developing a treatment plan.

Sometimes that treatment plan is, “Hey, let’s give him a liter of fluids under his skin—subcutaneous fluids. Send him home, offer him a little tiny bit to eat tomorrow, and see how he does.”

If he vomits, okay, he needs to come back. If he doesn’t vomit, great. He may poop out whatever this is.

Then we’re also going to decide: Is it something like the bowels on X-ray are very large and fluid-dilated? Is the stomach very large and fluid-dilated?

That indicates that there’s probably an obstruction somewhere.

And then, in that case, do we have a bouncing, happy dog? Do we have a dog that’s super excited to be there? Or do we have a dog that’s just laying flat out, not happy, painful, and has a high heart rate?

Does that dog need to be hospitalized?

If we’re going to hospitalize them, then we’re going to present estimates for treatment plans going forward, starting them on fluids aggressively if their cardiac status can handle it.

Then we’re going to go down the road of, okay, do we need to do recheck X-rays?

Rehydration is the first step. Recheck X-rays are the second step.

The bowels do not do their job if they’re dehydrated. We all know that if you start to get a little dehydrated, the first thing you feel is abdominal pain. Your bowels spasm.

So, it’s not going to push a sock through if it’s spasming and it’s dehydrated.

We’re going to do intravenous fluids and recheck X-rays after about six to eight hours, when that pet is better hydrated, to see if things have moved and whether the bowels, in general, look happier—or if we’re looking at potential surgery.

Jen Mellace:

Okay. And that was my next question. When do you recommend surgery in a case like this? And is an endoscopy part of this as well, as part of the diagnostics?

Dr. Sorum:

Well, endoscopy is not going to be part of the diagnostics, but that is something that is an option for treatment.

Surgery is never something that we enter into or recommend lightly because surgery is major. It’s the same in people. We don’t want to go into surgery if we can, in any way, avoid it.

However, there is a saying—and I’m a strong believer in this saying—that a chance to cut is a chance to cure.

If you’re avoiding surgery at all costs, you may end up with a pet that’s way sicker down the road.

The only way you can be 100% sure that this pet does not have an obstruction is to literally hold the intestines in your hands.

If you’re going into the abdomen, you’re going to run the entirety of the gut from start to finish, and you’re going to know there is no obstruction.

That’s an important thing to keep in mind.

The only way you can be 100% sure, especially in a young and otherwise healthy dog, is to do surgery.

Endoscopy is a great tool, and Partner recently acquired an endoscope. It’s part of our Internal Medicine group.

Dr. O’Connell does our endoscopies. It’s fabulous because it’s very, very minimally invasive.

However, it has some intense limitations.

At my last clinic, I used to do endoscopy quite a bit. It’s going to be something that, if the foreign obstruction is in the esophagus or the stomach—and sometimes, with a very skilled endoscopy technician or veterinarian, if it’s in the very proximal small intestine—you can get to it.

You cannot scope anything that’s beyond that because you can’t get there. Especially in a big dog, you’re not going to get there. It’s really, really difficult to see.

You also have to think that this scope, in order to grab something, utilizes something called a grasper. It’s just like a little tiny pincher.

So, scoping out something like a rock is really hard. It can be done. I’ve seen people do it.

You have something called a loop, which is kind of like a lasso, and it’s like driving a video game. You’re going to go down, you’re going to look at it, and if you can get that loop over the rock, great. You might be able to get it out.

If it’s a sock, you probably can get a hold of it.

If it’s a belly full of grass, there ain’t no way. You cannot get that out.

Also, think that endoscopy is under anesthesia. The dog is never awake during endoscopy because you have to go in through the mouth.

Abdominal surgery is always going to be faster.

I’m sure Dr. O’Connell is really fast at endoscopy, but an anesthetic time is going to be dramatically shorter if I’m going in with my hands, opening up the stomach, removing that sock, removing that rock, or removing whatever is out of the stomach.

The anesthetic time is going to be cut down.

So, if we have a pet who is older, has a cardiac murmur, has underlying renal disease, kidney disease, liver disease, we’re going to try to shorten the anesthetic time because it’s just not safe to keep the pet under for two hours.

We’re going to go in, get it done, and get them out.

And then, of course, things like bloat—like we talked about—time matters. It’s going to be as quick in and out as much as possible.

When we’re talking about surgery, I want to emphasize to owners especially that there is never going to be a time that we’re going to take your dog to surgery without talking to you first.

You will always talk to a veterinarian before we go into surgery.

I’ve had people call and say, “Oh, I thought you were going to take my dog to surgery.”

I’m like, “I’m never going to cut your dog unless I’ve talked to you about it and you’ve approved it.”

Of course, we also have to talk in depth about finances.

Surgery is something that, compared to the human world, we’re at a fraction of the cost, but it is something that we still need to be on the same page about as far as the finances are concerned.

A pet will have to stay hospitalized for about 24 to 48 hours after surgery.

And then there’s the recovery portion. Of course, we have to make sure that on every level everybody’s comfortable and we’ve done a lot of communication first.

My role, especially being on the weekend overnights, is that I’m going to be doing surgery at 3:00 or 4:00 in the morning.

So, owners, keep your phones on. We’re going to talk to you first.

I’m going to be doing a podcast on pet insurance and how important it is, if it can be afforded. That is a real lifesaver.

Jen Mellace:

It’s always a good idea. It allows you to have that kind of peace of mind and that flexibility to say, “Yes, go ahead. Let’s do everything that needs to be done,” without really having to stress over the financial part of it.

For sure. Can you explain what I’ve heard you say—a septic abdomen? Can you explain what that is and why a torn GI tract represents such a serious problem?

Dr. Sorum:

Yes.

Sepsis just indicates that you have infection in and throughout the entirety of the body. There are subtleties to that, but the GI tract is a tube.

It starts at the mouth and it ends at the anus.

That tube contains billions and billions of bacteria. So, essentially, we look at the bowels as being almost external. They’re external to the world.

That protection from the rest of the body is relying on the integrity of that tube.

So, when that bacteria gains access to the outside of the tube and the inside of the abdomen, bacteria really love that because, all of a sudden, there is all of this beautiful fluid that lives in the abdomen to lubricate everything.

It’s warm. There’s things like sugar and blood there, as there should be. And bacteria just go bananas, and they replicate without anything to stop them.

They will replicate very, very quickly.

Bacteria will die off, and then they kind of release their breakdown products, which get absorbed into the systemic circulation.

The body will immediately react by sending white blood cells in to fight off this infection, specifically the neutrophils.

So, we’re always going to look at neutrophils on our complete blood count to try to determine what numbers of neutrophils we have going on.

Are they high or are they low?

If neutrophils are low, that’s bad. That’s bad news bears because that means that they’re getting used up somewhere.

If this dog is really, really sick and it has low neutrophils, that’s a more serious condition and something that definitely warrants more investigation.

The immune system will start to react.

With a perforation in that bowel, the body will try to plug it up with different techniques. The formation of a plug with omentum—which is the fat and connective tissue that floats around in the abdomen—can help try to plug up that hole.

But if it’s unable to, and we have bowel fluid leaking actively into the abdomen, very quickly these pets can become shocky.

They can even go into cardiac arrest because the body’s fluid shifts and the massive inflammatory system reaction will create a loss of cardiac function.

That dog is going to look very, very different than a dog that just swallowed a sock an hour ago.

I’ve seen pets that have swallowed whole grill skewers—the whole skewer with the meat attached.

Those skewers sometimes are made out of metal, and then we can see them really clearly. Often they’re not. They’re bamboo.

Those bamboo skewers are impossible to see on X-ray because they’re made of bamboo. They’re not going to show up on X-ray.

But we will see free gas floating around in the abdomen. That’s not okay. That’s not normal.

We end up having to go in and do surgery on those.

The body’s going to try to wall off that infection. It’s going to build up a wall around it. Sometimes it’s successful, sometimes it’s not.

I think it’s really important at this point to talk about something called a linear foreign body.

Linear foreign bodies are very different in their pathophysiology.

A linear foreign body is going to be something like, in cats, sewing string or sewing thread.

Cats love to play with thread, and they will swallow it, and it’ll get anchored.

Dogs learn to chew and shred socks, towels, and blankets. It will also create strings that have kind of a wad of something that gets anchored first.

Jen Mellace:

What happens with rope toys, too?

Dr. Sorum:

Oh my gosh. Rope toys.

They’re terrible. Don’t buy your dog a rope toy.

That wad of fabric or whatever it is will anchor somewhere, and then the strings will go forward.

The intestines will push those strings, and then, as the string moves down the intestinal tract, it’s stuck at one location—that anchoring point—and then the intestines will pleat. They’ll bunch up.

If you imagine you grab the sleeve of your sweatshirt and pull your arm inside of it, all of that bunching is what the intestines do.

And that linear string on the inside will cut through the intestine as it contracts.

Eventually, it causes little, tiny, pinpoint perforations on the inside of that intestinal tract.

We see perforated bowels very, very frequently.

I had the unfortunate job of doing a forensic necropsy on a dog that had eaten a rope toy and passed away from it. That dog was septic because of the multiple perforations from this rope toy.

That is something that happens rather quickly.

If your dog chewed up, swallowed, and shredded something, that’s going to be a much more serious foreign body than just eating a rock.

Jen Mellace:

I will be going through my dog’s toy basket after we get off this podcast and throwing away all string toys because anything with strings, anything shredded, anything with bits hanging off—get rid of it.

Dr. Sorum:

Exactly.

Jen Mellace:

Yeah. That’s really important to know. So, thank you for that.

Somebody comes in and their dog needs to be hospitalized. What happens during the hospitalization and surgical removal of a foreign body?

Dr. Sorum:

Like I kind of said before, the most important thing is hydration first.

We’re not going to jump into surgery unless it is an emergent and time-sensitive situation.

We’re going to start them on parenteral therapy. That’s the difference between having your dog seen on an outpatient basis versus hospitalization.

With hospitalization, we place an intravenous catheter—a tube that goes into the vein, usually on your dog’s front leg.

We are giving them parenteral IV therapy.

We are not putting anything into their mouth because if there’s an obstruction, you put something into the mouth, it’s going to come right back out.

We’re also going to rest those bowels and try to decrease the inflammation.

We’re going to give IV fluids, IV antibiotics, and IV pain medication. We’re going to start treating all of this inflammation and irritation from the outside in.

If the blood work indicates we have an elevated white cell count and we need to start antibiotics, we’re going to do it.

If we’re looking at surgery, we’re probably going to start antibiotics prophylactically.

We are always going to do IV pain medication—things like opioids.

There are certain opioids that, of course, we’re not going to choose because they slow the contractility of the bowels, but we’re going to choose something that has wonderful pain relief and also keeps the dog—or the cat—from getting super anxious in the hospital.

Then we’re going to aggressively hydrate them.

There is a calculation. People always say, “When am I ever going to do algebra in my life?”

Become a doctor and all you do is algebra all day, every day.

Math is a big part of my job.

Kids, stay in school.

If you’re calculating out what a pet’s baseline hydration status is, and then what percentage of hydration you think they’re missing, you’re going to calculate that in.

Then you’re going to do a maintenance level of fluids times two, three, four. It just depends on how dehydrated you think they are.

We’re going to aggressively hydrate them so that the bowels can do their job better.

Once we get them to the point where they’re pretty well hydrated—I’m going to say probably four to six hours after initial hospitalization—we’re going to recheck X-rays.

We’re going to say, “Okay, it was here, now it’s here.”

There was gas. There was fluid dilation. Now it’s not. Everything looks better.

Once a foreign body makes it into the colon, you’re in the clear. They’re going to poop it out.

There’s never going to be a time that you cut into the colon. That shouldn’t happen, unless you’re removing a tumor. Other than that, you’re not going to cut into the colon.

So, if we’re making that decision at that six-hour mark and it’s not moved, things are looking worse, and he’s still vomiting, this dog is getting really sick.

We’re going to really push for a potential surgical exploration.

We’re going to make a phone call, talk to the owner, go through the positives and negatives, weigh them out, and then plan to do surgery.

Once we make that decision to go into surgery, there’s some lag time.

When owners get the phone call that we’re going to do surgery, we have to do a lot of things to get in and be fully prepared and ready to go to make sure that this pet is going to be safe.

We’re going to give premedications. We’re going to give induction drugs.

For induction, we’re often using things like propofol, the same as it is in people. If you go in for a colonoscopy, you’re going to know what propofol is.

We intubate them to protect their airway. We’re going to have a tube that allows them to breathe the whole time.

Then we’re going to lay them on their backs in a kind of V-trough, clip their bellies, scrub them aseptically, and then we’re ready to go into surgery.

That whole process takes a little bit.

The surgical table in the OR is warmed, it’s adjustable, and it’s at a V. We can even adjust the way their head sits.

They’re on IV fluids the whole time, and they’re monitored.

We monitor their heart rate, their end-tidal CO2, how much oxygen they’re taking in, and their blood pressure.

These are all parameters that are constantly being monitored during surgery.

We also have a lot of wonderful tools to minimize bruising, bleeding, and inflammation in surgery.

Something like electrocautery—we use scalpels, of course, but we also use electrocautery because it cuts and cauterizes the vessels to make sure that there’s not a lot of bruising.

We have something called a ligature vessel sealer that can cut and seal a vessel to minimize bruising and bleeding.

And then we have something called Nocita that we use perioperatively, usually postoperatively.

It is liposomal bupivacaine, and that’s just a fancy word for a numbing agent that’s been attached to a fat molecule. It’s infused around that incision postoperatively.

That incision is essentially numb for 72 hours as the body breaks that down.

That pet will be very, very comfortable.

I see pets come off the table and walk back to their run because they don’t feel it and they feel great now that the obstruction is out of their intestines.

And then also understanding that, now that you’ve removed that obstruction, you can’t make the inflammation go away completely.

They’re going to have diarrhea.

They are going to have diarrhea.

Usually they stay in the hospital so we can manage that part and you don’t have to clean up your floors.

But they will have diarrhea afterward. That’s just to be expected.

Jen Mellace:

And that was my next question. What can be expected after surgery, and what is the recovery time? Are there any potential complications? What should pet owners be aware of?

Dr. Sorum:

We call the first 72-hour window the critical window as far as intestinal surgeries go.

There are two different types of intestinal surgeries.

One is called an enterotomy, where I literally make an incision over the foreign body—or just kind of in front of it—pull it out, and sew it back up.

An enterotomy is the easiest of the foreign body surgeries.

Say that sock has been sitting in there for three, four, or five days, and our intestinal parenchyma has been kind of cramping on top of it, especially with really big obstructions.

It’s been stretched, and the bowel is trying its best to move it.

That bowel can actually die. It can become necrotic.

So, we have sections of bowel that are now black, and they can’t stay in there.

We do something called a resection and anastomosis, or R&A.

We’re taking that dead section out, making sure that we have beautiful, vital, normal intestine, and attaching it back together.

That is a more involved surgery because we then have sutures that go all the way around that tube.

That’s going to be a riskier surgery because that suture pattern is bigger. It has more risk of dehiscence.

That first three days is usually when we see the breakdown of the sutures if it’s going to happen.

You can’t always look at the intestines and say, “This is totally going to make it. This intestine looks great.”

You just don’t know until later.

During that first 24-hour period of hospitalization after surgery, our doctors are constantly doing an AFAST scan, where they’re taking the ultrasound probe, putting it on the abdomen, and checking to make sure the dog doesn’t have more fluid and that the intestines look healthy and are contracting normally.

Dehiscence is a complication. If you try to take your dog home too soon or you push it and they eat too much too soon, that can happen.

If we end up with dehiscence, they can become very sick afterward, and there is no way to prevent dehiscence if it’s going to happen.

So, coming home from foreign body surgery, there’s going to be an abdominal incision.

This is a dog that must, must, must take it easy.

Be in a crate.

And I am not even kidding when I say in a crate.

Leash, go potty, back inside in the crate.

We will give you medications to sedate them, but a dog that runs around and acts a fool, even though they feel great, can pop open their ventral abdominal incision.

Also, you’re going to do little, tiny meals more frequently. You don’t want to stretch those sutures on the inside.

Little, tiny meals.

Also, a very bland diet, easy to digest, nothing hard.

You don’t want to give a dog a rawhide after it’s coming home from gastrotomy surgery. That’s very bad.

Jen Mellace:

Dr. Sorum, can you tell us, are there certain pets, whether by breed, age, or personality, that are more prone to eating foreign objects?

The one that comes to mind is a Labrador. They’re notoriously known for eating things, right?

Dr. Sorum:

I’d say Labs.

But it’s always going to be like a young Golden Retriever who comes in. A two-year-old Golden Retriever who comes in bouncing around, and we always say, “What did you eat?”

So, I mean, your retrieving breeds, absolutely.

It’s funny because it doesn’t even matter the breed. There are just some dogs that eat things and then swallow things constantly.

I had a Schnauzer, and this was at the ER that I worked at in Maryland.

We cut him seven times.

By the seventh time, the problem is that, just like with humans, anytime you go into the abdomen repeatedly, they form bands of scar tissue called adhesions.

When you get to the point where you’ve cut a dog seven times and you’ve cut into their GI tract seven times, there’s so much scar tissue, and that intestine does not function normally.

It’s adhered together into kind of a giant glob.

So, I sat those owners down and I said, “Something has to change. You absolutely must do something to stop this dog from eating things.”

And they did.

He would bust into their rooms. He chewed up the dad’s CPAP machine and ate the entire nasal piece for the CPAP. They pulled that out of his pylorus.

He ate socks. He ate rocks.

Dogs tend to fixate on one type of thing. They love to shred blankets and beds. They all have their thing.

And even grass—dogs eat grass all the time.

My dogs do it. I’m not worried about that.

But if a dog has a tummy that’s upset and goes out and eats a giant wad of grass—I’m talking about mowing it down like a cow—that can be obstructive.

It can wad together, and that can be obstructive.

Jen Mellace:

Yeah. You know, I heard you mention grass earlier, and I made a mental note to ask you about that because it’s not something that you would think, “Oh, my dog’s eating grass. That could be a problem.”

But in excess, it can be, I guess.

Dr. Sorum:

Yeah. Oh, yeah.

The dogs that like to go out and eat after you’ve mowed the grass—the rows of grass clippings—the body is going to be able to break it down. It’s just going to take a while.

It’s fibrous.

And even things like a dog getting into a bunch of chicken bones—chicken bones get a bad rap, but they are metabolizable. They do get broken down.

It can cause a lot of other problems. It’s not necessarily going to cut through the intestines. I mean, it can, but they would really have to chew them up into shards.

Usually, though, it’s more that they’re so fatty that they cause pancreatitis.

The gastrointestinal foreign bodies are going to be nondigestible things. Fabric, plastic—those kinds of things.

I had a dog that ate and swallowed an entire Kong, the whole thing.

He very carefully induced vomiting and got it up, thank goodness.

But that was a big one, and that was something that definitely would have been obstructive otherwise.

Jen Mellace:

You know, we talked about the string toys. What can owners do to foreign-body-proof their homes?

Dr. Sorum:

If you have a dog who likes to carry around socks or underwear, or likes to chew up and shred things, just get them away.

I always think your laundry room should be closed.

If you have a dog that’s of this age, keep all your bedroom doors closed.

Close doors, and for heaven’s sake, put a lid on your trash can.

Trash cans should have lids all the time.

Especially if you have a dog that’s a counter surfer, you need to keep everything away.

It’s just like if you’re trying to baby-proof your home, you’re doing the same things—taking beds, Styrofoam, and stuff out of the crate.

And on that note, crate-train your dog.

Crate training is a phenomenal tool to prevent this from happening.

People think that dogs are so unhappy if they’re stuck in a crate.

If they’re stuck in a crate for 14 hours a day every single day, they won’t be happy.

But you are protecting them from themselves.

You are giving them a space that is theirs, that is safe, and that you know they’re going to be okay.

Jen Mellace:

Yeah. And many times, dogs who are crate-trained end up loving their crate. I know that my dogs do.

That’s their sleep place. That’s where they nap, they eat—that’s where they like to be.

What’s the difference in urgency and treatment approach between a foreign body in the stomach versus one lodged in the intestines?

Dr. Sorum:

The stomach is not just a big open bag.

It’s not just a big circle.

The stomach is kind of kidney-bean shaped.

The esophagus comes down to a main kind of holding tank of the stomach, and then it comes across into a narrow section. Then it goes out into the small intestine through a section called the pylorus.

The pylorus is kind of the narrowest portion of the stomach, and it tends to be where things get launched, mostly because that’s the outflow tract.

Things are moving from the stomach into the intestines via the pylorus.

If you have a pyloric outflow obstruction, that is something that is blocking anything from going from the main part of the stomach into the intestines.

That dog can be very sick.

Pyloric outflow obstructions can be pretty serious because that stomach will dilate huge.

The dog’s still wolfing down water because it thinks it’s dehydrated. It’s trying to hydrate itself. It’s thirsty.

But that fluid is then just flowing right back out through vomiting because it has nowhere to go.

The other thing I have seen in the past is dogs that have a shifting pyloric outflow obstruction.

Something—and this was a very sad case—but it was a Nerf football. It was foam, and the dog had swallowed it whole.

What happened is the dog was chronically vomiting over weeks and weeks and weeks and lost an enormous amount of weight because that foam football moved into the pylorus, blocked it, moved out, moved into the pylorus, and moved out.

Nobody really knew why this dog was consistently vomiting.

He had been seen five, six, seven times for X-rays, but nobody had done an ultrasound or gone in and done surgery.

So, once we’re talking about doing X-rays three, four, five times, we need to go to surgery. We need to do something to be aggressive with this.

That dog unfortunately did not make it.

But if you have something that gets into the stomach, typically we’re going to approach that and say, “Hey, let’s try to induce vomiting.”

We’re going to give IV apomorphine, which creates this really amazing abdominal press. They projectile vomit, and sometimes they bring out the thing.

I had a dog—a young Golden Retriever—who had eaten a big rock.

It was a big one.

They had sent him to me to scope out that rock.

I’m like, “Well, first of all, I’m not getting the rock out with a scope because it was palm-sized.”

But I talked to the owners and went through the risks of inducing vomiting.

And we did.

I induced vomiting, and I pushed while he was vomiting on the stomach. He brought that rock out, and it hit the floor with a clunk.

It had been in his stomach for about three months.

So, we were able to avoid surgery on a dog like that.

The difference in those two types of surgeries—gastrotomy, or cutting into the stomach, versus an enterotomy—is that the stomach is big and it heals really well.

There’s a lot of blood flow there.

Incisions into the stomach heal so well compared to incisions into the intestines.

That’s a much smaller tube. It’s much more delicate tissue.

Intestines tend to dehisce far more than the stomach does.

So, with the stomach, you can scope them, you can induce vomiting, and you can do surgery very quickly without a lot of complication.

Whereas with the intestines, it’s an obstructive thing where nothing’s going forward or back.

So, you’re going to end up looking at a more complicated surgery.

Jen Mellace:

For pet owners listening, what is the most important advice about prevention? And what should they do in those first critical moments if they witness either their pet swallowing something dangerous or they are pretty sure that’s what is going on?

Dr. Sorum:

The first thing is always to determine: Is that item toxic?

Did they swallow something that’s a little green block? Is it potential rat poison?

Is it a toxic substance?

The other thing that not a lot of people know about is xylitol toxicity.

If they get into your purse and you find a whole container of gum that’s been chewed up, that is rapidly fatal.

Xylitol-containing gum is very, very dangerous.

Things like Ice Breakers that contain xylitol—it’s like one gram of xylitol per piece of Ice Breakers, which I just don’t even buy.

Extra Sugar-Free is sorbitol-based, which is much safer.

So, is it toxic?

If it is, or you don’t know and you’re not entirely sure, call the ASPCA Animal Poison Control Center.

They’re going to tell you what to do.

We’re going to ask you to call regardless if we don’t know what it was that they swallowed—medications, that kind of thing.

Call Pet Poison first, then call either the ER, if it’s off hours, or your veterinarian.

If you watched that dog swallow that sock, there are ways to induce vomiting.

Hydrogen peroxide is the most famous.

Usually, we recommend about a teaspoon of hydrogen peroxide per 10 to 15 pounds of dogs.

(*Always talk to your veterinarian first)

Jen Mellace:

So, a teaspoon, and people like to just drip the hydrogen peroxide into their mouth?

Dr. Sorum:

No, no. It has to be in one whopping dose.

You have to squirt it down their gullet because that foamy, bubbling action, once it hits the stomach, creates the vomiting response.

That is something that everybody has at home.

So, that is a risk.

If you’re giving a dog hydrogen peroxide, you will cause a lot of irritation of their mouth, their esophagus, and their stomach.

You will cause ulcerations.

But it’s way safer to have an ulcerated bowel than it is to have a sock stuck in the intestine.

So, that’s risk versus benefit if you watch them swallow it.

Yes, we will recommend that you use hydrogen peroxide.

If it’s something where you do that and the dog doesn’t vomit, you’re going to head into either your veterinarian or the ER, and we will give an IV injection of something to induce vomiting if it’s indicated.

If it’s like a piece of glass, we’re not going to induce vomiting. That’s not a good idea. It’s going to cut everything on the way down and it’s going to cut everything on the way up.

If they get into bleach, we’re not going to induce vomiting. It’s going to irritate everything down and up.

In that case, we will call Pet Poison and try to decide what we’re going to do.

So, we’re trying to get it out, of course, but then we’re also trying to determine if your dog gets into a whole bunch of chicken bones or something.

It may not be something that they immediately have to be seen for or have vomiting induced.

We may indicate that you monitor going forward.

(*Always talk to your veterinarian first)

There are some situations where we will recommend monitoring.

People always kind of ask this question, but if you call the ER and you’re concerned, I’m concerned.

If you call and say, “Does my pet need to be seen?” I’m always going to say yes.

Mostly because I can’t diagnose over the phone, and I can’t tell you that your pet is ever going to be okay.

We’re always going to recommend coming in for an evaluation.

Even if it’s as much as you bringing the dog in, we look at it, maybe snap a single X-ray, and you say, “I think he swallowed a penny.”

Come on in. We’ll snap an X-ray.

No penny? Great. You can go home.

We’re going to make that decision based on an in-person exam.

We cannot. There’s no such thing as telehealth in these situations because that dog can’t talk to me.

So, I have to do a physical exam.

Jen Mellace:

No telehealth when they can’t speak.

Dr. Sorum:

If only they could. Boy, would that solve a lot of things for us, wouldn’t it?

Jen Mellace:

Dr. Sorum, thank you so much for taking the time to chat with me today.

I think a lot of this information is going to be super helpful to pet owners, and I know I learned a lot, and our listeners will too.

So, thank you so very much.

Dr. Sorum:

It’s nice because I have these conversations with individual owners all the time, and it’s nice to kind of broadcast it.

Jen Mellace:

For sure. Thank you.

Dr. Sorum:

Thanks. Have a great day.

Narrator:

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