ABSTRACT: This article gives an overview of a veterinary nurse's experience volunteering at the Esther Honey Foundation Animat Clinic in the Cook Islands. The fatal condition fish poisoning' that affects many of the islands' animals is discussed. Three case histories are summarised – two patients with 'fish poisoning', the other having a fractured ulna and radius.

In December 2009,1 spent two weeks at the Esther Honey Foundation Veterinary Clinic on Rarotonga in the Pacific Islands. Whilst 1 was there, the clinic housed approximately 50 animals, the majority being dogs and cats. Some were healthy animals that were at the clinic to be re-homed, whilst others required various levels of nursing care.

Orthopaedic challenge

Emma, a young female, stray, crossbreed dog had a fractured ulna and radius after being hit by a car a few weeks before I arrived. Her left foreleg was in a cast because orthopaedic surgery was impossible owing to lack of equipment and insufficient veterinary expertise – most veterinary volunteers are new graduates.

Unfortunately, we were not able to assess the progress of the fracture repair each time her leg was recast as the X-ray machine on site and the developer were not functioning, which was a common challenge in this working environment (Figure 1).

Figure 1: Emma showing off her new festive' cast

Emma certainly did not seem to suffer because of this. She was an easy patient to manage and followed the volunteers around while we carried out our duties, eventually being re-homed successfully with a loving family a few weeks after I returned home to New Zealand.

‘Fish poisoning’ patients

The patients that required the most intensive nursing were the ones that had the condition known as ‘fish poisoning’, which affects certain species of animal that ingest fish (dead or alive) that live in the inner reef of the lagoon on Rarotonga and other islands. These fish carry poisonous algae that develop after they have eaten a specific type of seaweed.

Cats and dogs are most commonly affected by this condition and during my visit the clinic had 13 patients with fish poisoning, ranging from those who had recently ingested the toxic fish to those nearing recovery. These patients require an immense amount of care over the weeks – and sometimes months – they are ill, especially where the severity of the condition could have led to either death or a prolonged recovery.

The common presenting signs of the condition were seen approximately 24 hours after ingestion of the fish. These included weakness, vomiting and diarrhoea, followed up to 48 to 72 hours later by nystagmus, inco-ordination, muscle spasms, irregular heart and respiration rate, collapse and finally, paralysis.

I have nursed many recumbent patients during my years working in practice, and I soon appreciated the importance of the basic nursing skills that I applied when caring for these critically ill patients.

Initial treatment of these patients included 24 hours of intravenous saline, along with a dose of mannitoi, to minimise the effect of the toxins on the nervous system. Diazepam was also administered to reduce the discomfort of muscle spasms. Whilst it was sad to watch animals with this condition deteriorate so quickly, it was gratifying to see those that recovered after a long period of debilitation.

Because of the paralysis and incoordination, the animals w'ere generally not able to move or lift their head, or mouths, to ingest food and water, so it was vital to ensure that they received adequate nutrition throughout the day, especially as the ambient temperatures were generally between 25-30°C. We did not have access to feeding tubes or high protein recovery diets and instead managed with basic brands of canned dog or cat food mixed with water to enable it to be syringed or hand fed (Figure 2).

Figure 2: Hand feeding a puppy with fish poisoning

Much of this food came through donations from the local people, grocery stores and clients; and it was important to inform them that the food must not contain any form of fish oils as this would aggravate the patients condition. This was also the case for animals that had recovered from fish poisoning.

Every day the dogs would be lifted and carried out of their enclosures onto the grass to get some environmental enrichment but also to make the job of caring for them and cleaning their accommodation easier. Diarrhoea was one of the ongoing symptoms of the condition, so it was imperative that they, and the area around them, were kept clean owing to the heat and (lies. Feeding, which took place outside, was quite a messy procedure, so the hose was always close to hand for a rinse down of both nurse and patient.

Physiotherapy and TLC

On my second day at the clinic, I was introduced to a very geriatric male dog called ‘Tiger’ who was in the later stages offish poisoning. He had a heart murmur and had not walked or eaten voluntarily for over a month. I initially feared the worst for this patient but decided to perform some light physiotherapy and joint manipulation on him for the first time since he had become paralysed.

As with all of the paralysed fish poisoning patients, I left him to have some time to relax on the grass feeling confident that he would still be there. On my return, a few minutes later. Tiger was nowhere to be seen! Thinking that one of the other volunteers had put him back in his enclosure I didn’t panic, until I checked his kennel and he wasn’t there.

Tiger had stood up and walked in the first time for weeks – right into the neighbour’s garden! Once over the shock of ‘losing’ a patient, we all managed to laugh about it and looked on with joy as Tiger enthusiastically munched through a bowl of food with no assistance (Figure 3).

Figure 3: Tiger on his way to recovery from fish poisoning, and securely tied up to prevent him walking off!

Throughout the rest of my time,

I made sure that each recumbent patient that I nursed received some form of physiotherapy. For the young canine patients that were now mobile this meant a refreshing swim in the sea (Figure 4).

Figure 4: Fun times – Weagle receiving physiotherapy in the sea

It was also important to turn recumbent patients every few hours and to ensure that they were placed in an area out of the intensity of the sun. The length of their recumbency and consequent loss of muscle tone meant that it was important to monitor areas that were prone to decubitus ulcers.

‘Dag dog’, a patient who had
been severely affected by fish poisoning, had a chronic, very deep, ulcer over his hip bone, which required packing with an antibiotic and granulating ointment and a dressing to protect it from the Hies (Figures 5 & 6).

Figure 5: Dag dog. paralysed from fish poisoning

Figure 6: Dag dog's decubitus ulcer

It was impossible to believe that he would ever return to full health, but I am pleased to report that he did so a few months later and, furthermore, he also found a loving new home.


The genuine and tolerant demeanour of these patients, even when they were so ill, made my time working on Rarotonga an enjoyable and unforgettable experience. It’s a trip I would recommend highly to veterinary nurses of any level. 


Selina Perrie

RVN A1 Assessor Cert Ed NCALE

Selina's veterinary nursing career started in 1997. She worked in small, equine and referral practices in the UK and Australia, and then in 2004 became a lecturer at Bicton College in Devon. In 2007. Selina emigrated to New Zealand to teach veterinary nursing and, in 2010, transitioned to Education Design.

To cite this article use either

DOI: 10.1111/j.2045-0648.2011.00081.x or Veterinary Nursing Journal Vol 26 pp 325-326




• VOL 76 • September 2011 • Veterinary Nursing Journal