Giving treats is second nature to most dog owners. It just goes with the territory. We dole them out to reward good behavior, to commemorate big occasions, celebrate good days and forget about bad ones. Very often, we give treats to alleviate guilt about leaving our dogs home alone. Countless dog owners say goodbye this way before going off to work every morning. Needless to say, they rarely look at it as a final goodbye.

That’s almost what happened to my friend Brenda a few months ago. At 5:30 AM, she went into her kitchen, ready to face another routine day. She made some tea, handed a couple of treats to her Chinese Cresteds, Sam and Twiggy and started getting ready for work. A few seconds later she noticed that Twiggy had not followed her into the bedroom, which was very unusual. That’s because Twiggy was lying on the kitchen floor partially conscious, experiencing intermittent seizures from oxygen deprivation. “Panic, fear, confusion, what to do?” Brenda instantly realized that Twiggy was choking to death on one of the treats she had just given them “Twiggy started vomiting foam and I started cleaning it out of her mouth, nose and throat trying to help her breath. Then she would gasp, seize, shake pass out. She would lie perfectly still for a few seconds then her eyes would roll and she would have a seizure. Then gasp, and start all over again. I scooped her up and she did the same thing in my arms.”

Twiggy’s story is typical. She simply fell over on her side, unable to move or make a sound. Depending on the type of obstruction, choking symptoms may include gagging, pawing at the mouth, gasping, and noisy exaggerated breathing, facial contortions or blue color of the lips and tongue. In Twiggy’s case, the partial obstruction caused her airway to become systematically blocked and unblocked.

Semi soft treats; similar to semi moist dog foods have become very popular in recent years. Bite size and chewable, they appear to be one of the safest snacks for toy breeds. Most dogs love them and they come in lots of interesting “people pleasing” shapes. “I had purchased these before” notes Brenda, “because I thought they were a safe size and easy for little dogs to chew, not to mention the festive eye catching party package.” As it turned out, the size, shape and texture of this particular item was an accident waiting to happen

Twiggy choked on an innocuous morsel about one inch long, oblong, and charmingly shaped like a fish. This included two protruding points at the tail end. Although these treats are easily chewed, toy dogs can, and often do, gulp things of this size. If a treat becomes covered in saliva this can happen involuntarily because it becomes too slippery to grasp or bite. Brenda’s vet theorized that this might have been what happened to Twiggy.

Once she had swallowed that fish, it’s irregular shape increased the chance that it would be stuck rather than sliding all the way down. Luckily, it produced only a partial obstruction. Since Brenda knew exactly what was down there, she tried to dislodge the fish with her fingers but it was too far down to reach. As she later learned, it was wedged in there at an angle that precluded easy removal.

Keep the dog as calm as possible. Struggling can cause a partially obstructed airway to become completely blocked. MA veterinarian and Pug breeder Dr. David Johnson, says  “first try to get it out with a finger sweep, but be careful. A panicky dog can bite”

Pull the tongue forward, extend the neck, insert an index finger into mouth. You may be able to see or feel the obstruction. Use a hooking motion to sweep around the mouth and into the back of its throat. “Sometimes this is enough to trigger a gag reflex” says Dr. Johnson, “which can help to dislodge the object.” Do not elevate the dog’s head or lay it on its back while doing this. And be careful not to push to object in further causing a worse obstruction. If the dog is foaming, vomiting or drooling, try to keep the fluids cleared from it nose and mouth.

If the obstruction is farther down, Dr. Johnson suggests trying a canine version of the Heimlich maneuver. “Lay the dog on its side and quickly compress the ribs 1 ½ to 2 inches. This must be done with a quick push and it must be done cautiously or you could break the ribs. With luck, the object will shoot out of the dog’s mouth. This maneuver may be unproductive if the dog is too panicky.” If this fails to dislodge the obstruction after 5-10 attempts, don’t waste more time trying. Head for the nearest emergency clinic. Keep the dog in a horizontal position while transporting it. Elevating the head will decrease blood flow to the brain, which can trigger cardiac arrest. Even if you do manage to get the object out, your vet should check the dog as soon as possible.

By the time morning dawned over Houston, Brenda’s plans for the day had been significantly revised. “Terrified, off I rushed to the ER. I knew she was going to die if I didn't get her to a vet. She had seizures this all the way there. I kept her body straight hoping that the treat would pass easier and I brought one of the fish to show the ER doctor what she was choking on. I didn't even realize I was in my PJ's till I got there!”

By 6:15, Brenda found herself at the emergency clinic, still in her pajamas, definitely late for work, receiving less than encouraging news from the vet. He had managed to dislodge the fish and unblock Twiggy’s airway. But after it moved out of her windpipe, it became stuck in her esophagus unable to pass over her heart. He informed Brenda that surgical removal might be necessary if he failed to get it moving down the esophagus.

“Emergency procedure will depend on the dog’s color and condition on arrival” says Dr. Johnson. If it is looking blue, I put the dog on oxygen, sometimes as a prelude to sedation. This may be the only way to remove the obstruction from a struggling dog. Sedation can be your best friend in these situations.”

With or without sedation, the vet will first try to retrieve the object with long forceps or an endoscope. “This must be done carefully, emphasizes Dr. Johnson, “ because the canine esophagus is unforgiving and prone to tearing and scarring.” If that fails, the next step is usually lubrication with mineral oil. Some foreign bodies may take two days to become sufficiently lubricated or dissolved to move. When using lubricants there is always a danger of inhalation pneumonia if aspirated.”

Eventually, the procedure was successful but it caused extensive bleeding. The ER vet feared that Twiggy had a tear in her esophageal wall. By then, Brenda’s regular vet was open for the day and she took Twiggy in for further tests. “My vet did a scope under light anesthesia to see if there was a tear and what was going on. Lucky for me during my panic I had remembered to bring the series of X-rays from the ER showing the fish traveling through Twiggy, and I did not have a wreck in the Houston rush hour traffic on the way over there. I sat outside the vet's office after dropping her off for the test still in shock and started to cry. Twiggy almost died because I had given her the DEATH FISH! I felt so guilty.” By the end of the day, Brenda was $1000 poorer and has yet to recover from the experience. “Twiggy got to come home that evening a bit groggy and sore. She is doing great now.”

Dogs can choke on just about anything if they set their mind to it. Choking on contraband items like serving forks, balls of twine and pilfered hero sandwiches is one thing. Watching your dog choke on a seemingly safe treat from your own hand is quite a different sort of shock. The standard advice of supervising dogs whenever they are given treats or chews doesn’t address some obvious contributors to many choking incidents.

The canine mouth is designed for tearing and shearing, not chewing. If a dog has something really good, it would rather chew as little as possible. Dogs do most of their chewing because they enjoy it, not because they want to savor the taste or aid their digestion. Their natural inclination is to grab and gulp first, think later- especially if a food’s texture invites this.

The texture is just as important as the size of a treat. Hard textured foods will crumble when bitten and soft foods will partially melt. It’s those in between items that can be really dangerous. This includes some of the most common things we give our dogs, like meat, cheese and semi moist dog treats. Never assume that these items are going to be chewed. Don’t offer pieces too large to be swallowed whole.

As soon as they are old enough to play with their littermates, dogs learn to grab and hold onto anything they value. If you discover your dog chewing on something it should not have, don’t turn it into a confrontation. The odds of swallowing that bottle cap, walnut or marble increase drastically if you are chasing the dog around the house yelling “drop it”. Keep the dog calm and try making a tradeoff by offering something more enticing.

Many choking incidents occur in competitive situations. Some dogs are naturally competitive eaters, much more likely to get into a “feeding frenzy”. It may be safer to avoid doling out treats to packs with this propensity. In Brenda’s case, Twiggy had already finished her treat and had set her sights on stealing Sam’s. She probably waited for Brenda to leave the kitchen to make a grab for it.

“I no longer give Twiggy or Sam or any future dogs any store bought treats. Only softened dog food and I make double sure I watch them like a hawk when they eat. My advice is never take it for granted, always watch them while they eat ESPECIALLY toy dogs.”