#11-What do you recommend for repeat rock eaters

What do you recommend for repeat rock eaters? Gastrotomy number 3 today:

Hi Zoe-

This poor dog and his owners really do need a solution. Avoidance methods like a basket muzzle or blocking access to rocks make sense but it may be possible to identify and treat the underlying cause. While behavioral etiologies are responsible for many of these frustrating cases your patient’s problem may be more likely to have a physical cause.

Research done on cats, rats, and dogs indicates that the rule-out list for pica should include anemias, lead ingestion, brain lesions in the dopamine receptors of the chemoreceptor trigger zone, or gastric disease involving the 5-HT3 receptors. Also consider portosystemic shunts, intestinal parasites, dental disease, electrolyte disturbances, and liver or kidney disease. Endocrinopathies like diabetes mellitus and Cushings can lead to hyperphagia. Drug side effects can do it too. Many affected dogs are chronically nauseated.

Excessive licking of surfaces (ELS), with or without pica, can be a red flag. A recent study by Ve´ronique Be´cuwe-Bonnet, Marie-Claude Be´langer, Diane Frank, et al found that a majority of dogs who lick incessantly actually had primary GI disease. “These abnormalities included eosinophilic and/or lymphoplasmacytic infiltration of the GI tract, delayed gastric emptying, irritable bowel syndrome, chronic pancreatitis, gastric foreign body, and giardiasis.” Treatment targeted to the specific etiology was instituted. “Significant improvement in both frequency and duration of the basal ELS behavior was observed in 10 of 17 dogs (59%). Resolution of ELS occurred in 9 of 17 dogs (53%).”

The take-home is that junk eaters need a GI work up in addition to their serum chemistries, CBC, UA and abdominal radiographs. Ultrasound can be valuable; endoscopic evaluation and biopsies are essential. A dog who passes all of these tests may very well have a behavior disorder.

Some dogs resort to eating rocks or other items because they lack adequate outlets for their natural canine behavioral requirements. Daily sustained, strenuous exercise, ideally off-territory with other dogs, is important for nearly every dog. They need to be all that they can be. We’re talking about a scavenger species; foraging opportunities like food toys and puzzles can completely replace feeding from a bowl.

There may be significant behavioral pathology. Dogs with separation anxiety may gorge on household items. A displacement behavior can be responsible in a dog who can’t or believes he cannot act out a necessary normal action. Elderly dogs with dementia (cognitive dysfunction syndrome) may start consuming unusual things.

Dogs with a history suggestive of a compulsive disorder can benefit from a serotonergic anxiolytic like clomipramine, fluoxetine, or sertraline. A reliable schedule of daily events also has value. Punishment should be completely off the table.

My experience has been that referral to an internist has resolved more than half of these cases of repetitive conspicuous consumption. We used to think that all of these junk collectors were behavior cases. Some still are.

I hope that’s not too much detail. Sometimes, if you ask me the time I might build you a watch.