We've all been there - waking up in the middle of the night to the sound of our cat hacking and retching up a hairball. Or better yet, not waking up and getting the squishy surprise of stepping in it the next morning. Ick. But why do cats get hairballs? When should you worry?

What is a hairball?
Cats are self-grooming creatures, so they ingest hair on a daily basis as part of their normal routine. They may also groom their friends and ingest hair from housemates. Have you ever noticed how rough your cat's tongue is? Those tiny papillae point backwards and help the cat catch loose hair and untangle knots. They also prevent the cat from spitting out most of this hair, so instead they move hair towards the back of the mouth to be swallowed. Most of this hair will pass through the GI tract uneventfully and be passed in the stool.  Sometimes the hair accumulates in the stomach or esophagus, leading to a hairball. When enough hair is trapped in the stomach it will often trigger the urge to vomit. Bringing up a hairball is usually an active process for most cats. They may make noise, hack, retch, or cough before bringing up the hair. A healthy hairball can be anywhere from 1-5 inches long, and is usually tube shaped from coming up the esophagus. The fluid around the hairball can range from clear to yellow to green to brown and still be normal. It will depend on how recently your cat ate and drank.

How many hairballs are normal?
Healthy cats can bring up a hairball on a weekly basis. Some will do so much less frequently (or never), and some cats will increase their hairballs during their twice yearly major shedding cycles. Cats who are distressed by their hairballs, vomit repeatedly, or bring up hairballs more than once a week should see the veterinarian.

Fall is here, and that means certain wildlife may be trying to make their way into your home to find a cozy spot for the winter. But don't reach for that rat bait just yet - take these simple precautions to keep your pets safe from poisoning.

Rat and mouse bait:
Rodenticides are poisons that kill rodents. They are frequently used to control mice and rats in homes, businesses, and some public areas. Unfortunately, children and pets are susceptible to the same active ingredients, so they are at risk for accidental poisoning.  ​There is no such thing as a "pet-safe" bait. They are designed to smell good to get the rodents to come eat them. I've seen dogs who moved rocks to dig up buried baits, who chewed through heavy plastic bait stations, who opened cabinets to get to refill packs. They are motivated by the smell and have no idea that the delicious treat is designed to kill.

• Anti-coagulant: these are the oldest type of baits and prevent blood clotting. They interfere with Vitamin K's role in the clotting cascade, eventually causing bleeding and death. Examples include Warfarin, Diphacinone, Bromadialone, and Brodifacoum. The latter two are single dose because they bind irreversibly to an enzyme and get stored in the liver, so the animal is affected long after eating the bait. Vitamin K can be used to reverse the effect of many of these baits, and your veterinarian will monitor your pet's clotting times closely to determine how long treatment is required. Unfortunately, the EPA banned the use of several anti-coagulants because of toxicity concerns, so the poison manufacturers moved on to chemicals with no antidote:
• Bromethalin: one of the most common types of bait currently available in the US is a neurotoxin. It causes nerve cells to swell, increasing the pressure in the brain. This leads to seizures, paralysis, and death. Unfortunately, there is no antidote to bromethalin when our pets are exposed. Treatment is limited to decontamination by inducing vomiting if the exposure was within the past 4 hours and giving repeated doses of activated charcoal to try the bind the toxin as it circulates through the intestines. Neurologic signs can develop within 7 days of exposure. These can include weakness, trouble walking, seizures, and death. These pets usually need to be hospitalized and medications given to decrease the pressure in the brain. Pets with mild signs can sometimes recover, but unfortunately those with severe signs will often die from their exposure.
• Cholecalciferol:  Vitamin D3. The popular bait d-CON now uses cholecalciferol instead of anticoagulants. Vitamin D3 is important in the body for calcium retention, and an overdose causes levels of calcium and phosphorus to soar. This leads to mineralization of organs and rapid kidney failure. Signs of cholecalciferol poisoning usually take 1-2 days to occur, by which time the damage can be permanent and sometimes fatal. Signs to watch for include increased thirst and urine, vomiting, weakness, lethargy, decreased appetite, and lack of urine in the end stages. It is crucial that cholelciferol exposure be treated immediately to preserve your pet's kidneys.

​So the bottom line is, if you value your pet's life, DO NOT BRING THESE INTO YOUR HOME. Choose integrated pest management instead. This starts by removing food sources that draw the rodents into your home, blocking the entrances, and using mechanical traps (placed far away from inquisitive paws and noses), glue traps, or live traps to remove the creatures already present. Click the link for more information.

On the other hand, ant and roach baits are rarely toxic to dogs and cats. They may vomit or have mild diarrhea, but ingestion is rarely an emergency.  An obstruction can occur, however, if they swallow the plastic or metal casing. If your pet eats an ant or roach bait, call your veterinarian or poison control with the specific active ingredient to verify whether or not any treatment is needed.

Antifreeze
Antifreeze is one of the most common pet poisonings in the United States, probably because it's commonly found in most homes. It frequently contains the toxin ethylene glycol, which can have a sweet taste that is attractive to dogs and cats. They will lick it off garage floors if it drips down from the car. The poison causes changes to behavior and quickly progresses to kidney failure.
Signs of antifreeze poisoning include:

• wobbly gait, acting drunk
• vomiting and/or diarrhea
• urinating more
• seizures
• rapid heart rate
• depression, acting dull, or coma

Seek emergency veterinary care immediately if you think your pet has consumed any antifreeze. A cat can be poisoned just from licking her paws after walking through an antifreeze spill, and consuming just a few ounces is fatal to a medium-sized dog. If you think your pet was exposed within the past 2 hours, induce vomiting with hydrogen peroxide (call us for the dose) and go quickly to the veterinarian. An antidote is available but only when used in the first few hours, before the kidney damage occurs. If the kidneys are already damaged then the poisoning is often fatal. Some specialty centers can perform dialysis to try to allow the kidneys time to recover, but this is not always successful.
How to keep your pets safe:

• Purchase antifreeze with the safe propylene glycol instead of the toxic ethylene glycol
• Keep antifreeze in closed containers out of reach of pets
• Dispose of used antifreeze properly
• Clean any spills immediately to prevent pet contact

Ah-choo! Cats can sneeze for a variety of reasons ranging from no big deal to serious illness. Here's how to tell whether to stay home and relax or call the vet.

Sneezing is a normal response to nasal irritation. Occasional sneezes are nothing to worry about, especially if your cat is immediately back to normal after the sneeze.

Sneezing can produce clear spray or thick snot. In general, clear spray sneezes are often viral or allergic in origin, while thicker green or yellow snot can mean bacterial or fungal infection. The nasal discharge can be present on both sides (bilateral), or just from one nostril (unilateral). Unilateral nasal discharge usually means something is structurally wrong, like an abscessed tooth or a foreign object stuck in the nasal passage. It always warrants a trip to the vet. 

When to see the vet:

• Any sneezing cat with a decreased appetite needs to see the veterinarian. Cats are very sensitive to smell, and many will not eat if they can't smell their food. A thick snotty nose definitely impairs ability to smell, so these cats need help quick. Offering smelly canned foods and tuna can perk up an appetite, and hanging out in a steamy bathroom or near a humidifier can also help loosen nasal secretions. 
• Fever is another reason to see the veterinarian. If your cat has decreased energy or is running a fever (most accurately measured rectally by your veterinarian), veterinary care is needed.
• Lethargy or trouble breathing - if the congestion impacts your cat's ability to play and exercise or if your cat ever appears to be in distress, seek veterinary care immedicately.
• Unilateral (one-sided) nasal discharge or bloody nose - since this often means there's a foreign object or structural reason behind the sneezing, seek veterinary care quickly.
• Thick green/yellow snot, or any sneezing that lasts more than a couple weeks

When you can wait:

• Acute sneezing with clear discharge and a happy cat - if your cat sneezes but is playful, alert, and has good appetite, it's usually safe to monitor at home for a week or so. Viral upper respiratory infections will run their course and you should see improvement after 7 days.
• Mild seasonal sneezing with clear spray - sneezing that recurs each year during a specific season may be allergic in nature. As long as your cat is otherwise acting fine you can try antihistamines at home as needed (talk to your vet about dosages).  Stop all smoking within the home, scented air fresheners, and candles, and install an air purifier to decrease inhaled allergens. This will minimize their discomfort.

 If in doubt, call us! While sneezing can be a normal sporadic part of a cat's life, any chronic sneezing or ill cats should be evaluated and treated. 

What are the risks of spaying and neutering?

• Myth: my pet will get fat. Reality: no, your pet won't get fat because of the spay or neuter. The reality is that excess calories for your pet's level of exercise leads to packing on the pounds. Our pets' metabolisms slow down after 6 months of age because they stop growing so quickly, so it's easy to over-feed them. See our blog post on how much to feed for more information.
• Myth: Spaying is risky and painful. Reality: at our AAHA-accredited hospital surgery is safe and pain is minimized. Our patients are monitored throughout their entire anesthesia and recovery, and we use multi-modal protocols involving small doses of multiple medications to minimize risk of side effects. Pain-relieving medication is used before, during, and after surgery. We want you keep your pet quiet and calm after surgery, but our clients tell us it's just about impossible because their pets are feeling so well they want to run and play.
• Myth: spaying and neutering is expensive. Reality: the cost of the spay or neuter is far less than caring for a single litter of puppies or kittens. Low-cost spay and neuter facilities that are subsidized by donations (like UCAN here in Cincinnati) make responsible pet ownership affordable to all.
• Fact: Spaying and neutering can slightly increase the risk for certain medical conditions in dogs. These are very breed and gender specific, and can be impacted by the age at time of spay or neuter. For example, urinary incontinence can occur in large-breed spayed female dogs, with the greatest risk occuring if they are spayed before 3 months of age.  Talk to us about your individual pet so we can determine the optimal timing to achieve the benefits listed above while decreasing any negative impact. The AVMA has the technical details here. 

Remember, the most important fact is that spayed and neutered pets will live longer on average than intact ones. Give us a call at 513-791-7912 and we'll be happy to answer your questions.

Did you know that summertime is flu season for dogs? Or that parvovirus is more common in warm weather? Summer is a great time to review your dog and cat's vaccines to make sure they're fully protected while they play.

Who needs what?
Vaccinations prevent infectious diseases. We carefully select vaccines that are safe, painless, and effective to provide your dog and cat with the best protection with the least risk of side effects. Vaccinations are divided into two categories by the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP): core and noncore. Core vaccinations are for every pet. Noncore vaccinations are selected based on what diseases are present in your area and your pet's individual risk factors and lifestyle. 

How to decide which noncore vaccines your dog needs:
Social dogs should be protected against kennel cough and dog flu. That includes dogs who go to day care, dog parks, grooming, or boarding facilities. It also includes dogs who may come into contact with friends on neighborhood walks. We've had 2 outbreaks of flu here in Cincinnati, and several boarding facilities even had to close temporarily to stop the spread. Both flu and kennel cough are airborne. They are spread by sneezing and nasal discharge.

Here in Cincinnati, we strongly recommend that all dogs be protected against leptospirosis because our local raccoon and opossum populations are carriers of the bacteria. The bacteria are hardy in moist conditions, so all it takes to get infected is for a raccoon to pee in your yard and your dog to sniff/lick the area. Then the bacteria multiply and cause damage to the liver and kidneys. Even more scary is that leptospirosis is contagious to people, so you are at risk if you come into contact with your sick pet's urine.

Lyme disease vaccination is not usually needed for dogs who stay in Cincinnati as long as they are on year-round tick prevention. That may change in the future, however, as our tick population becomes more infected with the bacteria and the risk for the disease increases. Dogs who are not protected against ticks or who travel to the northeast or northern midwest should be vaccinated.

Which noncore vaccines does my cat need?

​Cats who go outside where they may come into contact with other cats should be protected against FelV (Feline leukemia virus). That virus is spread through saliva, so sharing a water dish, mutual grooming, or fighting can lead to virus transmission. The virus can lead to a supressed immune system and even the development of certain cancers like lymphoma.

Cats who live with an FIV-infected cat can receive the FIV vaccine. This virus is transmitted from cat to cat by biting. Only cats who are microchipped should receive this vaccine, because it will cause the cat to test positive for the disease on the screening tests used in most veterinary offices. So if your cat ever gets lost, he or she might be mistakenly diagnosed with the disease and considered sick and contagious. FIV causes immunosuppression, making your cat more susceptible to infections.

Chlamydophila, Bordetella, and FIP vaccinations are rarely needed for cats in the Cincinnati area. 

Summer - it's time for the sun, backyard grill-outs, pool parties, and fireworks! But those bangs can be scary for our pets - so here are some tips for calming our nervous friends when the thunder starts crashing or the fireworks start booming. Here's what you can do to keep your furry friend more comfortable.

Signs of a nervous pet:
Pets who are anxious because of a storm or fireworks display may have mild to severe symptoms. They can be extra clingy and stay by your side, or you may see hiding and trembling. Nervous pets may pant, pace,  urinate or defecate, drool, or become destructive to furniture or objects if left alone.

Give them space
Provide a hideaway, preferably without windows and away from exterior walls. Bathrooms, closets, and basements are often soothing locations. Your pup may want to shelter in the bathtub, and kitty may find under the bed to be her place of refuge.
Start up the music
Playing music indoors can mask the sound of thunder or fireworks and make the loud noises less startling.
Dampen the noise
You can put cotton balls in your dog's or cat's ears to muffle the sound of thunder or fireworks. Dog  caps, ear muffs, and headphones are also available and may help make the noises less loud.
Promote calm
A tight jacket like a thundershirt can give your pet a constant hug feeling and helps through pressure points. Foods and supplements that decrease anxiety and promote calm responses can work wonders for fearful pets. These will usually work better if given daily, so are best started several weeks to a month before the scary event.  ​

Medicate if necessary
Some pets require more help than you can give at home. Pets who are shaking, urinating or defecating in the house, or are unable to eat or rest require stronger medications to decrease the fear and terror. This is important to make future episodes less scary, because fears can build over time and can lead to destructive behavior if not modified. These prescriptions include medications like Sileo, alprazolam or diazepam, gabapentin, and trazodone. ​We will decide together which is best for your particular pet.

I'm not sure there's anything redeeming about ticks. They crawl, they bite, and they carry diseases. Thankfully there are some easy ways to just say no to ticks this spring - and all year long.

Here's what you need to know to keep your pets (and your family) safe from ticks. 

1. Ticks can be tiny. A nymph deer tick is the size of a poppyseed, and can easily hide in fur, hair, or under jewelry. 
2. Ticks are active. There are 5 common species of tick found in the Greater Cincinnati area. Each has a slightly different life cycle, so the end result is we have ticks out and about every month of the year (yes, even in January). But May is the "tickiest" month - that's when the most ticks are active. 
3. Ticks carry diseases. Lyme disease, ehrlichiosis, anaplasmosis, Rocky Mountain spotted fever, and cytauxzoonosis are just some of the nasty infections that ticks transmit to the animals they bite. Some of these diseases can have long term consequences even with treatment, so this is one area where an ounce of prevention is more than worth a pound of cure.
4. It's easy to prevent ticks. First, create a tick-free zone in your yard. Ticks prefer moist environments, so they're less likely to venture to the middle of the lawn. Rake up leaves, cut back grasses and brush, and try to decrease wildlife traffic through your yard to keep tick numbers down.
   
5. Then, protect your pet. There are a number of safe, effective products to keep your dogs and cats safe. They come as oral chews, topical products, and collars. 

As you can see, there are a number of effective options available. Some are available in pet stores, others through your veterinarian.

• For households with children, the oral products - Bravecto, Simparica, and Nexgard - are often the best choice since there's no need to separate the pet until the product dries.
• For outdoor cats, applying topical Bravecto once every 12 weeks can be the most practical.
• The Seresto collar is a great option for pets who wear collars all the time.
• Vectra 3D has the added advantage of repelling mosquitoes, so it makes a good adjunct to heartworm prevention.
• Frontline and Advantix are readily available in pet stores (be careful not to purchase Advantage, which lacks tick protection).

Talk to us or your local veterinarian to find the best product for your pets' lifestyle - but the bottom line is that your dog or cat deserves to be protected from those tick-borne infections.

Found a tick? Now what?
Gross - you just found a tick. First, take a deep breath and don't panic. Next, how to remove a tick: grab a pair of tweezers, firmly grasp the tick as close to the skin as possible, and pull straight out. This applies to ticks on people as well as pets. The goal is to get the tick's head and mouthparts out if possible. Do NOT pour alcohol on the tick or try to burn it - those techniques just make the tick regurgitate more into the wound and increase disease transmission. Do save the tick and send a photo of it to the folks at tickencounter.org for identification. They will let you know what the risks are for that particular species, and then you can decide whether to pay to have your tick tested for diseases.
Watch for illness - watch your pet closely for lethargy, fever, limping, swollen joints, bruising, or changes to thirst or urination. These are signs of several of the tick-transmitted infections like Lyme disease or Ehrlichiosis. Seek veterinary care quickly if your pet becomes ill.  
Test for disease - make sure your veterinarian screens your dog every year for the most common tick diseases, even if you've been using prevention. This can usually be done with a few drops of blood right in the office. A positive result means your pet has been exposed to the organism, and further testing is needed to see if treatment is recommended.

April is First Aid Awareness Month, so here are the essentials - and how to use them - for your first aid kit.

What to do if your pet is choking:
A choking pet will have difficulty breathing, may paw or rub at his or her face or mouth, may cough or retch, and may have blue-tinged lips or tongue.

• If your pet is pink and can still breathe, keep him or her calm and seek emergency veterinary care.
• If your pet is having trouble moving air or is turning blue, look into the back of your pet's mouth. Do this by using one hand on the upper jaw and one hand on the lower jaw and rolling the lips over the teeth. Remember, any dog or cat can bite, so proceed cautiously. If you see an object, try to remove it with tweezers or pliers, or hook it out with a finger. Be careful not to force it farther back into your pet's throat.
• If your pet has collapsed and is blue-tinged, and you can't clear anything from the mouth, you may need to perform the Pet Heimlich maneuver.
  • Small dogs: gently place a small dog on his or her back. Use one hand to apply pressure to the abdomen just below the ribcage, then check the mouth for any dislodged pieces. You can also place one hand on either side of the rib cage in a standing small dog and press inwards sharply 3-4 times, but this maneuver has the potential to fracture ribs so should be used last.
  • Large dogs: if standing, reach around your dog and place a fist on the belly just below the ribcage. Place your other hand flat on top of the fist, then move both hands in a sharp thrust up towards the ribcage.  For large dogs on their sides, stabilized the spine with one arm and use the other to push the belly up towards the ribs. Then check the mouth for any dislodged pieces. If you are not successful, you can strike the ribcage firmly with the palm of your hand 3-4 times to try to force the air out of the lungs and dislodge the object, but this is a more risky maneuver that can cause rib fractures.
• Head to the veterinarian immediately - but please drive safely. Getting in a car accident will only slow down your pet's access to care!

February was Pet Dental Health Month, so we're going to focus on those (hopefully) pearly whites today. Not so pearly or not so white? Probably time for a checkup and professional cleaning. Because even veterinarian's dogs get dental problems too, here's my Truffle's dental story from last month.

There is a new swelling on the left side of her face, underneath her left eye. Trace the jawline and it will become more clear (I'm sorry, she's a black fuzzy dog so photos aren't as obvious). The picture to the far right has the swelling outlined in red.

The most likely cause of a lumpy swelling on the face in dogs is an infected tooth. If the whole face is swelling or the eyes are swollen, think allergic reaction and seek treatment immediately. Unfortunately, tumors are also a possible cause, especially in older pets, so it's important to get a diagnosis quickly to address the problem.

After a week of antibiotics, Truffle's face was almost back to its normal shape. This made a tooth root infection the most likely reason, so we proceeded to dentistry to find the culprit.

This is what Truffle's teeth looked like once she was asleep. The orange tube goes into her airway and is connected to an anesthetic machine  giving her oxygen. It allows us to closely adjust how deeply she's asleep and even breathe for her if necessary, and is one of the many precautions we take to ensure safe anesthesia. 

Not too bad, right? But on probing carefully around each tooth, I found a pocket in the center of the largest upper molar. We took x-rays:

After the bad tooth was surgically removed, the gum was stitched back together to provide quickest healing time. Here is Truffle's mouth at the end of the procedure.

A week after the dentistry, I let Truffle start chewing on rawhides and dental treats again. Her mouth is pain-free, and the swelling on the side of her face is much improved. She may never be exactly symmetric again, but now she has a chance to heal and the source of the infection is gone for good.

So here's the moral of the story - even teeth that look ok can hide some pretty nasty problems. Have your pets' teeth checked every time they visit the veterinarian, and follow up with an anesthetic dental cleaning if recommended. Scraping the teeth while your pet is awake will miss a problem like Truffle's every time.

Heartworms are scary, and unfortunately, they're here in Cincinnati. We earned the dubious honor of being the city with the fastest growth in the country of new heartworm cases last month. You can't see them, and they can make your dog or cat seriously ill. Heartworms are parasites that live in the heart, lungs, and large blood vessels of dogs and cats. They are transmitted as microscopic larvae by mosquitoes. Luckily, there are effective ways to prevent your dog and cat from getting heartworms.

As you can see from these maps, heartworm disease is steadily spreading across the country, and unfortunately Cincinnati is now in the red zone.​ We'll get the next updated map in 2020.

How do you get heartworm disease?

From a mosquito. A mosquito bites an infected dog, and ingests baby heartworms, called microfilaria. She then carries these microfilaria to the next dog or cat, and infects the pet when she feeds.

Those heartworm larvae now spend 2 - 4 months migrating through the tissues of the new dog or cat, growing up into adult heartworms when they reach the vessels of the heart. Heartworms can grow to be over 12 inches long, and can live for 7 years inside your dog. The heartworm preventions are only effective during the first 2 months from infection by the mosquito. 

What should you do?

Protect your dog and outdoor cat every single month with heartworm prevention.
Common tasty chewable brands include Sentinel, Interceptor, Heartgard, and Triheart. Topical heartworm preventions are also available for cats and dogs - Revolution and Advantage Multi. There are many options, and they're all just about equally effective at preventing heartworms from reaching adulthood as long as they're given monthly. There is even a long-acting injection, ProHeart 6, which provides 6 months of protection.

We can help you decide which heartworm prevention is the best for you. They are all slightly different in what other parasites they treat, but they are equally effective at preventing heartworm. But they all MUST be given EVERY SINGLE MONTH in order to work. Talk to us about which particular medicine is best for your pet's lifestyle. Once those baby heartworms become adult, they are resistant to the preventatives and your pet needs treatment for the disease.

How to diagnose heartworm disease:
A couple drops of blood is all it takes to check your dog or cat. ​Here at Montgomery Animal Hospital, we will also screen your dog for tick-borne infections with the same test. Check with your vet about which test is being run, since some tests screen for heartworm only.

How to treat heartworm disease:
Heartworm treatment is a long, arduous process for dogs. There is NO treatment for cats - we are limited to supporting their hearts and lungs as best as we can until the worm dies on its own, a process that can take years. While it's worth it in the end to save your pet's life and lungs, it's not a fun thing to go through. 

• The first step is staging the disease to see how much damage has been done - this requires bloodwork, urinalysis, and chest radiographs.
• A heartworm prevention is given under medical supervision to stop the spread of heartworm disease and prevent any more worms from reaching adulthood. Often steroids and antihistamines are used too to reduce the chance of allergic reaction when the microfilaria are dying.
• Next, an antibiotic is given for a month to eliminate a commensal bacteria, Wohlbachia, that supports the heartworms. Without this bacteria, the heartworms start to wither and are less likely to produce the baby microfilaria.
• A month later, the first dose of melarsomine treatment is administered to start eliminating the weakened heartworms. Here's where the danger intensifies. The injection kills some of the heartworms, and now the dog's immune system must digest the worms to get them out of the blood vessels. But if the dog runs, plays, or has any excitement that quickens the heart rate, those worm pieces can be thrown into the circulation and cause a fatal blood clot. This injection is painful, and we support the pets with pain relievers and use steroids to decrease inflammation as the worms die off.
• One month later, the next two doses of melarsomine are administered. The exercise restriction remains strictly in place for another 6 weeks to allow the immune system to digest all the worm pieces.
• Finally, 5 months after diagnosis, the dog is allowed to run and play again. Bloodwork in 6 months is needed to confirm that all the heartworms were eliminated, and if not, the process starts again.

warning - graphic photograph below