Heat Stroke

bulldog outside in the sun

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This episode is a must listen for anyone with a dog and provides the tools you need to prevent and save your dog’s life from heat stroke. For a pet left in a car when the temperature outside is 72 to 96°F, the temperature inside the car rises an average of 41°F within 30 minutes. 80% of that increase takes place within the first 5 minutes.

Cracking the windows makes no significant difference, even on breezy days.

Pre-cooling with air conditioning makes no significant difference.

Dogs cannot cool themselves as efficiently as humans can, and the panic they experience trapped alone in rising temperatures worsens the already excessive panting. Certain breeds, like English Bulldogs, Pugs, French Bulldogs, Boxers, or overweight dogs, are at a higher risk. Bringing your pet to an emergency vet as fast as possible will help save their life.

Welcome back, Dr. Klippen

[00:01:05] Dr. Lancellotti: Welcome, everyone, to today’s episode of Your Vet Wants You To Know. Today, we’re going to be talking about heat stroke. It’s getting a lot warmer these days and this is something that we talk about every year. There is such a big risk to animals when they are out with their owners, especially when they’re in the car. It’s something that emergency veterinarians see all the time. Today, I have with me, emergency veterinarian, Dr. Christine Klippen, who has been on some of our other episodes talking about dog toxicities, cat toxicities, as well as Feline Lower Urinary Tract Disease. She is going to talk today about heat stroke and what you can do to prevent this from happening to your pet, what the risks are, and what you can do if you find yourself in a situation where your animal has become overheated. Welcome back to the show, Dr. Klippen. Thank you so much for being here.

[00:01:58] Dr. Klippen: Thanks for having me.

Christine Klippen with cat on shoulders

Is Heat Stroke Common in Dogs?

[00:02:00] Dr. Lancellotti: I know this is a really important topic, so why don’t we just dive right in and tell our listeners what we’re going to be covering today? What is it that makes you feel so strongly about this? 

[00:02:11] Dr. Klippen: Unfortunately, heat stroke is, as you said before, something that I see very commonly as an emergency doctor and it is a devastating problem. It’s devastating to the family and can be devastating to the pet. A lot of people don’t actually understand the gravity of heat stroke and the actual very high mortality rate associated with it. In our area, we have a lot of people that drive Teslas. And one of the features that a lot of people were excited about was the ‘safe mode’ or the ‘air condition mode’ that can be controlled by a person’s phone. Several years ago, I remember a case that we had, literally the year after the Tesla model had come out, where a family had gone shopping, had left their dog in the car, and thought everything was safe because their phone and all of the monitors in the car were telling them that it was a safe temperature. Unbeknownst to them, the monitors had malfunctioned and the dog had suffered heat stroke. When they got to the hospital, we did absolutely everything that we could, but unfortunately we were not successful and lost that patient. And it was so devastating because it’s such a potentially preventable problem.

[00:03:35] Dr. Lancellotti: That must have been absolutely heartbreaking for those owners. I think what a lot of people don’t realize is just how quickly a car will start to heat up. Even on just a semi-warm day (not even a blazingly hot day), within just a few minutes, those cars really start to increase in their temperatures. And the animal doesn’t know what’s happening inside the car. They just know that they’re getting hot and that their owner is not there to help them. Dr. Ernie Ward, a friend and colleague, did a video of himself sitting inside of a hot car, and how quickly the temperature goes up was just dramatic. So he’s sitting there for (I think) about 30 minutes and there’s a massive increase in the temperature. You can see the breeze blowing outside the cracked windows and you’d think, “Oh, that’s got to help with the heat and keep the car cool,” but it absolutely does not. 

Dr. Lancellotti: Can you talk to the listeners about what happens when an animal becomes overheated, and what their body tries to do to cool itself off and stay at a normal body temperature?

[00:04:58] Dr. Klippen: We see heat stroke as a result of a number of different issues. I think the one that we see most commonly are animals that have been accidentally left in hot cars, but it can also happen as a result of a pet exercising during the heat of the day, having lack of access to shade or water, or if they have an underlying medical condition that prevents them to normally dissipate heat. There’s not a specific ‘definition’ of what type of body temperature occurs with heat stroke. And you can see body temperatures anywhere between 104 to 110 degrees Fahrenheit. And for reference, a normal temperature in a dog or a cat is less than 102.4.

[00:05:48] Dr. Lancellotti: Yeah. So they normally run a little bit hotter than humans do. But 104, that’s hot for anybody- dog, cat, human, etc.

How do dogs stay cool?

[00:05:55] Dr. Klippen: Normally, there are different mechanisms in place for people, as well as animals, to be able to dissipate heat and to be able to function within a normal temperature range. So in people, we may see an increase in our heart rate, we may be breathing harder, we may see sweating, or flushing of the skin. As a redhead, I will always look like I’m dying in the heat because that is my body’s natural response to help cool my body off. On the other hand, dogs are a little bit different. Because they don’t have the ability to sweat, they lose heat more from radiation (heat coming off of the body) as well as convection (air moving across the body and across their mucus membranes). We can see a little component of evaporation as well, because when dogs get hot, they pant. And as they’re panting, they’re bringing air in through their nose and their mucus membranes, which are a fairly large surface area inside of their nose, because the mucus membranes will cover all of these little bones within their nose called the nasal turbinates. So this helps cool down their body because blood is being brought to the surface in these mucus membranes, but the problem is that when we have environmental humidity, that also plays a factor. When the environmental humidity is greater than 80%, which is a good majority of the south, as well as up and down the east coast, this mechanism is lost.

[00:07:37] Dr. Lancellotti: Yeah. We don’t have that problem as much here in Los Angeles, where it doesn’t really get humid, but I remember growing up in Pennsylvania and then visiting places down south as well. During those hot summer months, you’re just covered in sweat because the humidity is so high. So I imagine, in those places, that humidity really gets in the way of having evaporation be an effective way for an animal to cool itself.

[00:08:03] Dr. Klippen: Yeah. The key thing is that it may not necessarily seem like a hot day, but if it is super humid, then the heat index (how hot it actually feels) is also a very important factor in these particular pets.

What happens when a dog gets too hot?

[00:08:23] Dr. Lancellotti: What happens once those cooling mechanisms aren’t able to function properly anymore?

[00:08:30] Dr. Klippen: Once the body gets to a critical temperature, then we start to see changes at the cellular level. We can see complications of heat stroke, including multiorgan failure or collapse of the cardiovascular system. We may see some central nervous signs, such as things like comas. I’ve seen animals be drunk looking. They’ll develop seizures. I’ve seen animals have swelling of the brain. We can see bleeding into the GI tract, kidney failure, and then difficulty with clotting the blood. 

How can you tell if a dog is overheated?

[00:09:06] Dr. Lancellotti: Those are all things that we can see, as veterinarians, when we’re doing our physical exam and running diagnostics. What is a pet owner going to recognize?

[00:09:16]Dr. Klippen: What a pet owner may notice is vigorous panting. You bring the pet in, or you get them to an area of shade, and they are just panting so heavily that they’re not able to catch their breath. Very commonly, we will see excessive drooling and the saliva that comes off of their mouth is very viscous and sticky looking. Some people will describe what’s called a spade-like tongue, which is when an animal is trying to cool itself off and their tongue becomes very wide and very long. You may see brick red color to the tongue or the gums. And if you were to put your hand on the side of the pet’s chest, you may notice that they have an elevated heart rate. They may be having difficulty breathing. Owners may notice staggering or what looks like drunkenness. I’ve had pets collapse, as well as having vomiting and diarrhea (sometimes, with blood in it). Those are definitely major red flags for heat stroke.

[00:10:19] Dr. Lancellotti: You had mentioned earlier that the normal body temperature for dogs and cats was less than 102 degrees Fahrenheit. For pet owners who may be able to feel their pet’s heart rate on the side of its body, what’s a normal heart rate for a small dog versus a big dog?

[00:10:37] Dr. Klippen: I think for a small dog, I would say anything that is maybe about 120 to 140. Whereas, a bigger dog, maybe greater than 90 pounds or so, I would expect a normal heart rate to be between maybe 80 to 110. If you’re starting to see those heart rates that are jumping outside of the norm, those can definitely be a concern that there’s something going on.

What dog breeds are at risk for heat stroke?

[00:11:05]Dr. Lancellotti: What types of situations might the owners notice these clinical signs start to appear? When are animals going to be at an increased risk, and what activities do the owners need to be careful of? And are there any particular breeds of animals that we need to be concerned for?

[00:11:23] Dr. Klippen: I think the biggest culprit for heat stroke that we see the most commonly is as a result of being locked in cars. In warmer and humid climates, like here on the east coast, we can also see heat stroke occur with pets being left outside without access to shade or water. I think that the pets that are at greater risk are brachiocephalic breeds (smooshed-face breeds- bulldogs, pugs, Frenchies, etc.) because they inherently have an altered anatomy, so they may not be able to be as efficient with that panting and cooling technique. The other types of pets that we will see that are at risk are a little bit overweight, the very young and the very old, and then pets with underlying heart and respiratory problems. Dogs that may have signs of laryngeal paralysis or chronic lower reactive airway disease (chronic bronchitis), or even dogs that are under treatment by a cardiologist as a result of heart disease, are not going to be able to dissipate that heat as appropriately. 

[00:12:33]Dr. Lancellotti: How about those dogs that are more climatized to cooler climates (Huskies, Akitas, etc), that you would more likely find on a sled-dog team than hot summer days in the south? 

[00:12:50]Dr. Klippen: A lot of Northern breeds like Huskies and Malamutes will have what’s called a double coat. They’ll actually be carrying more hair to them because they’re acclimated to colder climates. That actually is a benefit for them there, but not so much in a hotter climate. We can also see dogs at risk for heat stroke if they’ve had heavy long hair, as well as being dark in color. If they’re black or dark brown and don’t have access to shade, they’re going to be at greater risk for potentially suffering heat stroke. 

[00:13:28] Dr. Lancellotti: Because they’re absorbing all the sun’s rays and just holding them against their body. You mentioned before about the cooling mechanisms that dogs have and how they use those mucous membranes in the mouth to help exchange heat and evaporate moisture. Those smooshed-face breeds, like the bulldogs, don’t have nearly as much of a surface area in their mouths, as well as their noses, to be able to help with that exchange of heat. They’re just getting overheated very quickly, so it’s probably not a good idea to take the overweight geriatric pug on a 10 mile hike in the middle of July. 

[00:14:04] Dr. Klippen: Oh yes. And don’t take up jogging with that patient either. 

How to quickly cool an overheated dog

[00:14:07] Dr. Lancellotti: I had a case, when I was an intern working in emergency, of an English bulldog who came in for heat stroke. This case was just heartbreaking because the dog was actually inside the owner’s bedroom with the air conditioner running, because it was an insanely hot day here in Southern California, so the owner was trying to keep the dog cool inside while they were out for the day. And while they were out of the house, that air conditioner actually broke and started forcing the hot outdoor air into the enclosed bedroom, where this dog was supposed to be staying cool. Despite their best efforts at keeping the dog cool, the dog suffered from heat stroke because of that unfortunate accident with the air conditioner. Very luckily, we were able to provide support and he did make a full recovery. The pet owners were very swift in getting him over to the hospital, as soon as they got home and realized that there was a problem. But if an animal does become overheated, no matter the cause, what is the first thing that a pet owner should do if they want to save their pet’s life? 

[00:15:14]Dr. Klippen: Believe it or not, most of the recommendations that we have regarding heat stroke are usually anecdotal, and there’s a lot of debate, in both human and veterinary literature, regarding heat stroke and what we consider prehospital interventions. But again, in both the human medicine and veterinary medicine, what we all agree upon is that the time at that very hot temperature is what is causing those problems that we see. So trying to get them out of that danger zone, to bring their body temperatures down, we are less likely to have those ongoing complications.

[00:15:58] Dr. Lancellotti: So you want to try and get them cool as quickly as possible. 

[00:16:01] Dr. Klippen: Correct. Currently, our recommendations are to immediately remove a pet from the sun or other sort of heat source, and then try to cool them with either cool or lukewarm water. The reason why we choose cool or lukewarm and not ice or ice-cold water, is the concern that they can develop what’s called vasoconstriction, where all of those little blood vessels that are in the extremities can clamp down, as a result of the cold, and potentially shunt the blood away from the extremities, not doing what we’re trying to do- cool these pets. 

[00:16:45] Dr. Lancellotti: So if those blood vessels start to constrict and close off, and the blood vessels on the surface are doing that, those blood vessels are no longer able to get rid of the heat that the animal is holding onto, and that heat gets trapped inside the body. Is that what I’m understanding?

[00:17:03] Dr. Klippen: Yes. We want to reach for either cool water or lukewarm water, so that they’re not having that clamping down of those blood vessels. 

[00:17:10]Dr. Lancellotti: Could you use something like wet towels to get an animal cool? 

[00:17:17] Dr. Klippen: Personally, I really like things like using the hose or bottles of water. I’ve had owners put an animal into the bathtub to cool them down. The reason why I’m not a huge fan of the towels- they can be used in a pinch, but I like for owners to pull them off of the pet. The airflow (trying to encourage evaporation and convection) to get that hot air off, doesn’t occur as well when there’s a heavy towel sitting on top of them. 

[00:17:50] Dr. Lancellotti: So you’re trapping the heat you’re trying to get rid of. 

[00:17:52] Dr. Klippen: Correct. 

Get to the emergency vet FAST!

[00:17:54] Dr. Lancellotti: So after they get the animal wet using that cool or tepid water, what would you recommend then? 

[00:18:00] Dr. Klippen: In these cases, I would run the air conditioning, I’d roll down all of my windows in the car (if I’m still in a vehicle), and that will also help cool them down. But I think that one of the most important things, other than cooling, is getting them to a veterinary office. What they’ve found is that patients and pets that have been actively cooled by their owners, and following up with an emergency vet or a veterinary hospital within 90 minutes to 2 hours after recognizing signs of heat stroke, can actually have a better outcome, compared to those that present a lot later afterwards. 

[00:18:39] Dr. Lancellotti: So get to the hospital as quickly as you can. 

[00:18:42] Dr. Klippen: Yes. This is not a “wait and see” sort of situation. 

[00:18:47] Dr. Lancellotti: Yeah. Sometimes the consequences of heat stroke aren’t readily apparent, so it’s important to make sure that a veterinarian assesses the animal for that organ damage that may not show up immediately, but only as a consequence of the animal being overheated for an extended period of time. Just like we discussed in the dog and the cat toxicity episodes, sometimes, the signs of illness can be delayed. Knowing where your nearest emergency hospital is can save you that crucial time and getting your pet the immediate care it needs, and making sure that there aren’t problems developing after you’ve gotten your animal cooled off. 

How to prevent heat stroke in dogs

Dr. Lancellotti: What would you say are the best ways for pet owners to prevent heat stroke in their pets? 

[00:19:33] Dr. Klippen: Just like with you and I, we need to be acclimated to warmer weather. So, check in. Talk to your veterinarian to find out whether or not your pet may have an underlying condition, which may prevent them from enjoying the outdoors with you. I think that the first time to go out and start jogging with your potentially overweight pet is not the middle of July, in the middle of the day. It’s something that, hopefully, you have been training for and working up to. When we talk about military working dogs (who will spend a lot of time in 125 degree ambient heat, which is very uncomfortable), they have worked for weeks to months to get those dogs acclimated to those sorts of environments, so that hopefully, they aren’t going to have signs of heat stroke. So we would expect the same for your lab or shepherd that you want to go hiking with. It’s something that they need to work themselves up to.

[00:20:39] Dr. Lancellotti: Yeah. Just like if you were to ask me to go run a marathon, I probably wouldn’t be able to do that for you right away. I’d probably have to go jog a mile first and then work my way up to it because I’m not one of those people. I’m kind of like the lab in that situation. I’m probably going to collapse just a few miles in. It’s not a good idea for me. How about some other tips for pet owners? 

[00:21:10] Dr. Klippen: We never want to confine our pets in hot or humid spaces. I think that being very cautious if you’re traveling with your pet, and making sure that you are not leaving them in the car, because that can definitely heat up very quickly. If you live in an area that does happen to get very hot and very humid, avoid exercising pets during the warmest times of the day. My rule of thumb, especially when gets very hot here in the DC area, is ‘dusk and dawn.’ So you can go out and do some fun things with your pet at dusk and at dawn, because then it’s not that very high heat index. 

[00:21:51] Dr. Lancellotti: So you don’t have the sun working against you. It may still be really humid, but hopefully the heat is manageable. 

[00:21:58] Dr. Klippen: Yeah. Always make sure, if you are going to do things to enjoy your pet outdoors, that they have access to shade and water. Just like with you or I, we can get overheated really quickly, so we need to be cognizant of our pets when they’re doing things with us. 

[00:22:18] Dr. Lancellotti: How about for those special breeds we were talking about before, the brachycephalics or smooshed-face? 

[00:22:25] Dr. Klippen: With the brachycephalic dogs, which have become very popular over the years (I probably see three to five Frenchies a day in our area), know what the signs of heat stroke are. Know that they are different than a lab. They are different from a golden retriever or a shepherd. They are going to have many more differences and be a lot more sensitive to the heat. Learn to figure out what those signs are ahead of time, and then be proactive. Again, I’m not a big proponent of hiking with pugs and bulldogs. I think that they do much better with quieter, less strenuous sorts of environments. Especially, when it’s hot. When it’s cold outside, then by all means, but not during the heat of the summer. 

[00:23:17] Dr. Lancellotti: Right. So at summertime, that overweight, geriatric pug should probably take its walk first thing in the morning, as you lazily sip a cup of iced coffee and not during the heat of the day. 

[00:23:26] Dr. Klippen: Exactly. That sounds wonderful.

Do not leave pets in your car

[00:23:28] Dr. Lancellotti: What are some of the big takeaway points that you want pet owners to remember about heat stroke in pets? 

[00:23:36] Dr. Klippen: Understand that the mortality rate is actually upwards of 50%, so it is a pretty serious and significant disease. The most common complications that we will see of heat stroke are usually kidney, as well as multiorgan failure. So, prevention is super key in these guys. 

[00:23:57] Dr. Lancellotti: And preventing means making sure they’re not going out during the heat of the day, they have access to shade and water, and that you’re not leaving them locked in the car. 

[00:24:07] Dr. Klippen: Yeah. Believe it or not, a lot of states now have actually outlawed leaving pets in cars, and will allow first responders to intervene if they feel that a pet is deemed at risk. This can not only be costly to you, from tickets to potentially broken windows (if they’re trying to rescue a pet in potential distress). But I have known situations, in my area, where pet owners have lost ownership of their pets as a result of leaving them in the car.

Should my dog sunbathe?

[00:24:37] Dr. Lancellotti: Wow. There isn’t a summer that goes by that I don’t see reports of people breaking car windows to get dogs out. Now that car is damaged, that pet can be injured or potentially die, or both. So, it’s definitely something you want to be aware of. Now, Dr. Klippen, my husband wanted me to ask you about our dog, Molly. She is 15 now (and I know you do not have a veterinary client/patient relationship with her). In general, she’s always been kind of a sunbather. She has access to shade and water all the time, but she likes to lie in the sun (by preference) until she is panting her head off. Are there some dogs who just don’t know any better? 

[00:25:18] Dr. Klippen: Oh, absolutely. I grew up with a black lab that used to cook herself on the front driveway. Just like with you or I, we like to sit out and feel warm. And I’m sure it feels great for her old lady joints and everything. I think that it’s fine, but in small amounts. Because again, she probably gets quite a bit of enjoyment from it, but she may need breaks. And she may not know any better that she needs breaks. Periodically, bringing her inside and letting her lay on the cool tile floor- I’m sure it probably feels just as good as being outside. 

[00:25:53] Dr. Lancellotti: Yeah, we definitely yell at her to get back inside (not because she’s a bad dog or that she doesn’t know any better, but) because she’s mostly deaf now that she’s 15, so you have to yell to get her attention. But I will let him know that as long as we continue to give her breaks, and keep an eye on her, she should be okay with the enjoyment she gets from her old lady joints getting nice and warm. I want our listeners to know that many family veterinarians are comfortable managing pets that have become overheated or showing signs of heat stroke, but you should always have the number to your local emergency hospital programmed into your phone. Have the address programmed into your phone also, so you know where that is, and you can get there quickly, saving those valuable minutes. There is a link to find a critical care veterinarian near you on the website under the resources tab, if you’d like to consult with a specialist. You can also view the references for today’s show in the show notes on the website as well. If you have gotten enjoyment out of the show, I would encourage you to take a moment and just hit the subscribe button. You can listen to more episodes as they come out and leave us a quick review, so that other people can find value in the show as well. 

Scratching the Itch

[00:27:08] Dr. Lancellotti: I wanted to end the show, like we do, with the Scratching The Itch segment. This is a segment that’s designed to highlight something- either a human interest story, a product, or a website that either provides relief or just makes you feel good. Hence, scratching the itch. Dr. Klippen, I’m actually really excited about your ‘scratching the itch’ today, because I think this goes beautifully with the episode. Will you tell our listeners what you have that provides relief and will make their pets feel good? 

[00:27:38] Dr. Klippen: There are two products that I have seen over the years, and have routinely recommended for families that are going out and about and doing things with their pets, as well as those pets that may be a little bit more predisposed to developing heatstroke. The first one is something called a cooling vest. These look like little harnesses that have a special material on there, which helps soak up water. What you can do is submerge these little vests, putting them in the refrigerator or freezer, and they will help keep the bodies of these pets cool. I think these are great for your bulldogs that are traveling in the car with you to keep them cool. If you are going out and about and are hiking with a pet and you’re like, “Ah, I’m not sure if they’re going to get overheated,” I think that this is a great way to help regulate their body temperatures and help bring them down. The second thing that I’ve seen (and my own family has used this, as they live down south now) are these little cooling beds. They’re made of this special material that automatically cools, once in contact with water. It’s kinda like the towels that you can put around your neck if you’re out exercising.

[00:29:02] Dr. Lancellotti: Oh, nice.  

[00:29:03] Dr. Klippen: It’s the same sort of thought process. You can put these cold things out and dogs can lay on them. And again, hopefully this brings their body temperatures down, to give them some relief, so that they’re not getting themselves into trouble. 

[00:29:18] Dr. Lancellotti: This may be an interesting thing for us to add to our back patio, so Molly has a place to cool herself off, without having to go back inside. 

[00:29:27] Dr. Klippen: Yes. Absolutely. 

[00:29:29] Dr. Lancellotti: That’s great.  

[00:29:55] Dr. Klippen: Of course. 

[00:29:56]Dr. Lancellotti: I love this picture of you with the cat. What is happening here? Is this cat just talking or what’s going on? 

[00:30:05] Dr. Klippen: Yes! This is a kitten who had a lot to say. It was funny because you can tell that his owners, obviously, held him this particular way. When you open up the kennel, he knows exactly where to jump. He jumped up onto my shoulders to pretty much yell at everybody that walked by him. He wasn’t my patient for the day, but he had so much to say, that I needed to get in there and love on him. And sure enough, he told everybody about it. 

[00:30:38] Dr. Lancellotti: I love it. This is such a great picture of you and this cat. <I’ll have this on the website for listeners to check out.> And I love how his tail is curled around your head. I did a double take when I saw this picture of the first time because it almost looks like you’ve got this beautiful braid across your head, but it’s actually his tail. It’s adorable. Thank you very much for coming on and talking to everybody about heat stroke. I hope this helps to save some lives. 

[00:31:05] Dr. Klippen: Thank you. I hope so, too. 

[00:31:07] Dr. Lancellotti: And for everyone listening, I look forward to your next visit with Your Vet Wants You To Know.

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