From chocolate to Vicodin, fielding daily crises and solving the mystery of grapes
Dr. Tina Wismer, a veterinary toxicologist, marks 25 years working at the ASPCA Animal Poison Control Center this year. The job can be stressful, and one way Wismer blows off steam is to create more during her hobby as a glassblower.
Dr. Tina Wismer is good on the phone. The veterinary toxicologist wears her considerable expertise lightly. She's self-deprecating, eschews jargon and gets to the point.
She's honed these communication skills over 25 years at the ASPCA Animal Poison Control Center, where she is now senior director of toxicology. The 24/7 not-for-profit hotline takes calls about potential animal poisonings from pet owners and veterinarians. On the phones and at the helm, Wismer regularly helps people through frightening moments, supports veterinarians as they navigate complex cases and translates poisonings data for reporters.
The VIN News Service asked Wismer to share some of what she's learned in her quarter of a century on the frontlines, when animals (primarily dogs) swallow things they shouldn't.
The following interview is edited for length and clarity.
How have your role and responsibilities changed over the years?
When I started here, I was one of the people answering the phones. I'm a night owl, so I worked the overnight shift for about 13 of those years. Then I transitioned — I kind of went to the dark side, right? — to management. I am much more involved now in the writing of protocols so that all of our cases are handled in the same manner to make sure our medicine is consistent. I also do a lot of the media touches, so I get to talk to a lot of reporters.
Is the overnight shift the busiest? It seems like everything goes wrong at night.
Because we take calls from across the United States, our evening tends to be the busiest between 6 p.m. to 1 a.m. We're in Central time. You can watch the calls kind of roll across the country. The East Coast is getting home from work now and seeing what their animals have gotten into, then Central, then Mountain, then California. It's interesting watching the trends. I still do work some time on the phones. Also, as a senior toxicologist here, I do a lot of consulting. If newer veterinarians have any questions on case management, I'm more than willing to help them out.
Do veterinarians answer all the phone calls?
Right now, we have about 65 veterinarians. If you call from a veterinary clinic, our phone system recognizes that, and your call will be directed to a veterinarian. Calls from the public will ring into what we call the public line, which is staffed by veterinary technicians. We have about 135 of them.
Why the distinction between the public and veterinarians?
Typically, when veterinarians call, it's usually a much more involved case, so to save time, we shunt them directly to veterinarians so that we have a better use of our resources.
Do most of your team take calls from their homes?
Most of our employees are remote. There are still probably about a dozen of us here in Champaign, Illinois, in the office. But we have people who man the phones all across the country.
What's a typical day like?
Oh, it's crazy. When I first started, there were a total of 13 people — vets and support staff. Over the years, the call volume has gone up. Our calls have also gotten more complicated. People aren't calling us about the silica gel that the dog ate. We're getting a lot more "dog got into Grandma's purse; these are all the medications and the gum and everything else." Veterinarians, I think, are much more comfortable now managing a lot of the easy stuff on their own.
Can you remember your best day?
My best day? I really like to solve the puzzle. That's the best part of my job. When I get the call from the veterinarian who's got this dog, and they're having these clinical signs, and they're like, "What do you think?" I give them differentials. And sometimes they're like, "Well, yeah, you know, there is that medication in the house." And then we can track down the actual cause of the problems.
Have you ever been unable to solve the puzzle?
Unfortunately, yes. Sometimes, we may think it's a toxicity, but it's not. Right? I mean, maybe it's cancer. Maybe it's some type of metabolic disease.
Do you know what happens after a phone call is complete?
We do follow up some of the cases. At this point, we don't follow up a lot of things like chocolate or ibuprofen, because we have a lot of data on those. Other things, like newer medications or things that just don't fit, many times, we will follow those up.
How do people working the calls learn how to talk to distressed pet owners?
It is a big part of our training. How do you deal with panicked people? How do you make them focus? How do you deal with that difficult, angry caller? Not only is it knowing the medicine; there's a lot of customer service that's involved. If I know the answer, but I can't get it across to the owner, it's not helpful.
How do you stay calm when a pet owner is angry?
Sometimes it's hard. I mean, we all have our triggers. But knowing that typically the person is worried about their pet, and you're not the cause of it, can help. And you need to take some time after a phone call, walk around the desk, do some breathing.
Are callers charged a fee?
There's a flat fee of $95, and that includes as many phone calls as it takes to get the case resolved. So that could be one, or that could be 20 to 30 if it's one of these vitamin D cases that takes a couple of months to get totally resolved. So many times, we will start the case with the owner, and then they go to the veterinarian, and we help the veterinarian manage the case. There's just one fee for it.
As you know, many states require practitioners to examine a patient in person before they can make a diagnosis and prescribe treatment. How are you able to help patients without violating that requirement?
Poison control centers … fall under kind of a Good Samaritan law. It's a public immunity doctrine. When telemedicine became a thing and the American Veterinary Medical Association was concerned about it, poison control centers were actually called out as an emergency service that is allowed.
What are the most common types of poisonings? I imagine this has changed over time?
So, for dogs, it is chocolate — so much chocolate. I think that's because people know that chocolate is a problem, right? Veterinarians have done a great job over the past 30 to 40 years saying chocolate is poisonous. Certainly, we're seeing an increase in things like xylitol and vitamin D. Things that are going to be commonly found in the household are things we're going to get a lot of calls about.
What about for cats?
I'd like to think cats are smarter than dogs. Dogs gulp things down and think, "Huh, I wonder if that was edible?" Cats? Lilies are one of our most common things that we see cats getting into.
In terms of how you respond to the different types of poisonings, what are the most common interventions you suggest?
Even though a lot of things are poisonous, animals don't necessarily always eat enough to cause problems. We talk a lot about monitoring animals at home and watching for clinical signs, whether that's vomiting or diarrhea.
How about when pets have been brought into the clinic because they are showing clinical signs. What kinds of things are you working with the veterinarians to do?
For those, it can range anywhere from giving an antiemetic — something to stop the vomiting — to giving fluids. In some cases, we may be recommending things like dialysis or, you know, therapeutic plasma exchange. It depends upon who we're talking to and what resources they have.
I'm one of those owners who had a dog get into chocolate — twice — and he was given activated charcoal to absorb the theobromine and caffeine, which are toxic to dogs. I've heard it's become less frequently prescribed. Is that true?
I would say we probably are using less charcoal than we used to for a couple of reasons. No. 1, we have more data on: “Does it make a difference in poisoning?” No. 2, we have some other options that maybe have fewer adverse effects or less potential to be problematic than we used to.
What are the potential adverse effects of charcoal?
So, vomiting is very common after charcoal. We always worry about aspiration, inhaling charcoal into their lungs. And large amounts of charcoal can also cause fluid shifts. Charcoal pulls free water into the digestive tract. We can sometimes see these animals developing hypernatremia — high sodium — which can cause neurologic signs.
Have toxicants changed over the years? Are you seeing harder drugs, for example?
Fortunately, we don't see a whole lot of fentanyl in dogs. The cases that we do see tend to be in police dogs that are doing service. We get a lot of opioid calls. But, typically, it's the "I dropped my pill of Vicodin, and my dog ate it." The owners are worried about the opioid part of the Vicodin. However, we veterinarians, are way more worried about the acetaminophen part of it because pets are way more sensitive to that than people are.
I think you've maybe sort of answered this already, but I wondered who gets into bad stuff more often — dogs or cats?
Always dogs. I want to say, like, 84% of our phone calls here are about dogs.
What other animals have you gotten calls about?
We get a few calls about a lot of random species — small mammals that are kept as pets, backyard chickens, birds, fish in ponds. Occasionally, we'll get a call from a zoo. A lot of times the zoo calls are like, "Hey, we'd like to put this plant in our enclosure; is it going to be toxic?"
Do you have veterinarians on your team who specialize in some of these more exotic animals?
We do have several people who have a background in avian or zoo med, and we also have people who have a lot of experience with large animals. That is certainly not my forte. We have a lot of people who have a little niche. Mine is poisonous plants. We have other people who focus on serotonin medications or cardiac medications.
I wasn't thinking about cardiac medications or S.S.R.I.s. The more you talk about these different things, the more I see how huge the world of risks is.
I tell you, when you take calls for a year, it really changes your worldview. You're like, "Everything is toxic!" and it's true. It's just the amount that it takes to be problematic.
I read that you do retrospective research on report data. What is an interesting finding to come out of that work?
Probably the most interesting thing is one of our most recent discoveries, and that has to do with why grapes and raisins are toxic to dogs. Way back in 1999, one of the veterinarians on the hotline noticed that he had had two calls that week of dogs getting into grapes or raisins that developed kidney failure. We had said it's not related. Well, electronic databases are a great thing. He went back and found a double handful of cases of dogs developing kidney failure.
We sent a letter to the editor of the Journal of the American Veterinary Medical Association, saying, "Hey, there seems to be this relationship that's going on." Over the next few years, we had people around the country and, actually, around the world, publish papers on dogs getting into grapes and raisins and developing kidney problems.
Later, we had a dog that got into homemade play dough. Typically, these animals usually get salt toxicity. But in this case, the play dough recipe used cream of tartar instead of salt. This dog developed kidney failure and, on necropsy, had the same lesions that the animals that get into grapes and raisins do.
That led us down this rabbit hole of what is the cream of tartar. It turns out that cream of tartar or tartaric acid is a byproduct of winemaking. There are papers published back in the 19-teens and 1930s that describe giving tartaric acid to dogs and them developing kidney failure.
We had wondered, “Why don't dogs that get into things like grape jelly or grape juice develop kidney failure?” It turns out those products are detartrated. They remove the tartaric acid because it precipitates out and it looks like ground glass, and no one wants that in their juice and jelly.
And there was just a paper published this year that showed tartaric acid causes problems in the dog kidney cells but not the human kidney cells due to a lack of an organic acid transporting molecule. It's amazing, right? All of this data comes together at the end.
I work with some pretty smart people that were able to put this all together.
If there was something you could get pet owners to do consistently to protect their pets, what would that be?
Oh, gosh, right. You know, pet-proof their home, make sure they can't get into the brownies that are on the table. Take your medication away from the pet. Things like that are probably the most important.
What about for veterinarians?
I would make sure that whenever they send home any kind of chewable medication, warn the owners, “These taste good. What makes it easy to give the dog one pill also means that if it's available, they're going to eat the entire bottle.”
What is the most important advice you have for veterinarians who have a patient where the poisoning is suspected, but the poison is unknown?
It's all about treating the clinical signs that are there, right? If the heart rate is too fast, we need to slow it down. If a blood pressure is too low, we need to bring it up. It does not matter what the cause is. You just need to treat the clinical signs.
What have you learned about humans from working at the animal poison control center?
I have learned that people, when they get stressed, can be mean. They can be nasty. But a lot of those people call you back after the episode is over. They apologize and they thank you for what you've done for them.