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Hookworms Kill

June 19, 2011
tan american pit bull terrier puppy with a 1/4 inch wide and 3 inch long white stripe down the center of her nose, lies with her chin on the table and her legs out to the side

Lethargic APBT Puppy

8-Month-Old American Pit Bull Terrier Puppy Fights Unknown Intestinal Illness and Anemia

Amber, a golden-eyed red-nosed APBT presented at Doc Truli’s hospital for 2 days of lethargy and vomiting.  Never having visited a doctor before, and never having received any vaccines of any type, any thinking person with some knowledge of dogs would think…”parvo virus.”

Lethargy, anemia, vomiting, pit bull, no vaccines, puppy.  But something did not fit.  The parvo patients get profuse bloody diarrhea as the virus attacks the rapidly-dividing cells of the intestinal lining.  Amber had no feces production for 2 days.  The parvo test was negative.

Intestinal parasites are almost ubiquitous in dogs who do not receive treatment and preventative.  A fecal test for worms was negative.  Doc Truli dewormed Amber anyway, as there is a 25% chance of a false negative result on a fecal float microscopy test.  Besides, dewormer is inexpensive, has a huge safety margin, and can save lives. So, why was Amber so sick?

So now you think, “no poop for two days?  Must be obstruction!”  …Right?  Vomiting, not making stool, unable to hold down food, inquisitive young puppy.  Puppies indiscriminately put everything into their mouths (they seem to have that in common with human babies.)  So, we took abdominal radiographs of Amber.  No obstructive pattern.  We gave barium.  It sat in her stomach and looked like it wasn’t going anywhere.  So that means obstruction or ileus.


“Ileus is stasis if the gut.  The normal peristaltic muscle wave-like motion of the gut stops and contents in the intestines just sit there.  The bacteria makes gas and the body floods the intestinal lumen with fluids.  A big, soupy, smelly mess ensues.”

Amber’s Anemia

Amber came to Doc Truli with mild anemia.  Her hematocrit was 31%.

“Hematocrit is a measure of the percent of the blood that is red blood cells versus the clear serum of the blood carrying proteins, nutrients, etc.  It should be 35%-55% in most Earth mammals,” says Doc Truli.

Amber spent the night on painkillers, antibiotics, intravenous fluids, and dewormer in case of parasites.

pale pink mucus membranes on the gums of this American Pit Bull Terrier puppy

Pale pink often means anemia

The next morning, she could barely breath.  Her hematocrit had dropped to 17% overnight – in 8 hours!  There was no external bleeding.  No bloody stool, no fluid pattern in the lungs on x-rays, no bruising or bulging of the skin or muscles to indicate internal bleeding.

We started a blood transfusion with fresh whole blood from a client’s dog who volunteered to help.

Amber passed away two hours later.  Her big, rectangular, blocky head rested on a soft cotton blanket, Doc Truli’s forearm under her cheekbone for support, her Amber eyes growing dimmer as her eyelids fell shut for the last time.  We were very sad and frustrated.

What Happened to Amber?

Amber’s parent’s approved a necropsy.

“Necropsy is the word you use when you perform a post-mortem examination on a species other than your own.  For example, a human doctor performing a post-mortem exam on a human calls the procedure an “autopsy” because it is same-species.  If a dog were to perform a post-mortem on another dog, it would also be an autopsy.  When Doc Truli performs a post-mortem exam on a dog, it is called a necropsy, as Doc Truli is human,” says Doc.

Amber’s body tissues were almost white.  She had almost no blood in her muscles, so they appeared salmon pink instead of red.  Where was all of her blood?

“When performing a proper necropsy, you ‘run the bowel.’  This is what it’s called when you start at the lower esophageal sphincter, on the stomach side of the diaphragm, and you open up the intestinal tract and examine the gut lumen,” says Doc Truli.

Amber’s stomach contained barium which the ileum had prevented from entering the intestines.  The small intestine looked horrible!  Purple-red blood clots everywhere!  Thick, red, sore intestinal walls looked almost worm through in some places.  The colon was hard and tubular.  Doc cut into the colon with the #10 scalpel blade.  The colon was full of hard, knotted, dried melena.

Amber had bled internally into her colon and intestines, and the blood congealed and hardened until it looked like petrified wood inside her colon.  The fecal parasite test was negative because the wood-hard column contents prevented any egg or worm shedding into a fecal sample.

White intestinal wall and red clotted blood in intestines killed this puppy

Red clotted blood, also note the white muscle walls of the intestines next to the red.

As Doc Truli held her breath to steady a camera to document the blood, the lining of the intestines caught the light and seemed to be glistening and writhing!  What was happening?  A closer look revealed millions of 1/2 inch (1 cm) long white thin worms writhing all over the surfaces of the intestines!  Amber died from hookworms.

What Is Unusual About Amber’s Case

Usually, hookworms are treated at puppy visits when a puppy is 6-16 weeks old.  Usually monthly heartworm preventative also prevents hookworms.  Usually hookworms show easily on a fecal float test.  Usually dewormer easily kills them.  Usually anemia is gradual and there is time to stop the worms and the blood loss, or time to give a transfusion and let the body heal.

Nothing was usual in Amber’s case and she lost her life.  Please deworm your puppies.

What You Can Do About Hookworms

  • Clean up the feces when your dog relieves himself or herself, as these worms are spread fecal-orally.
  • Encourage your town to enforce “pooper-scooper” laws.  They are essential to protect public health.
  • Hookworms are zoonotic.  Do not allow children to play in uncovered sandboxes, or dirt animals can use as a toilet.
  • Wash hands after gardening or playing with pets.
  • Keep your cats and dogs on monthly prescription heartworm and intestinal worm preventative.

Hookworm Puppy Miracle Story

3 Comments leave one →
  1. August 6, 2011 2:16 pm

    After years of not using HW meds because they gave Gadget seizures, I put Barnum on Heartgard (regular, not Plus) last summer, then switched to Iverhart Plus this summer. Now, I just found out about this lawsuit. Do you know if the problem is specific Heartgard Plus or is it ivermectin they are talking about, which is in all Heartgard and Iverhart products? In which case I should switch to what?

    • August 7, 2011 1:39 pm

      Dear Sharon,

      I never told any client that any product was 100% effective. I know there’s research collecting data to see if the products are loosing their effectiveness. As a doctor, I can tell you I prescribe these products every day and I have no internal conflict over it.

      Please follow your veterinarian’s advice, as she or he is the primary care provider for Barnum. Remember how instant information at your fingertips can disproportionately represent reality.



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