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

Winter weather is here in Cincinnati and it's time to bundle up. Keep your pets safe from the cold with the following tips.

'Tis the season for gift-giving! Here are some safe presents to get your pets in the holiday spirit.

4. Treatment of Diabetes
Insulin therapy and diet change are the mainstays of diabetic management. Cats and dogs respond better to different types of insulin, and most require twice daily insulin injections. Your veterinarian will work closely with you to make sure you are comfortable handling the syringe, drawing up the medication, and giving the injections. Be prepared to see a lot of your veterinarian in the initial stages while we adjust the dose to best treat your pet. We will measure the blood sugar at certain points in time to make sure that the level is never too high or too low. If you are comfortable measuring blood glucose at home then we can teach you which monitor is most accurate for pets and how to get the blood sample you'll need.
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Diabetic dogs tend to do best with a high fiber diet. Cats, however, will respond best to a high protein diet. Some cats can even stop needing their insulin injections (achieving remission) after their diet is changed and they've been treated for a few months, although they still require periodic monitoring because the DM can recur later. 

5. Complications

• Hypoglycemia (low blood sugar) is the most urgent of the potential complications. This can cause weakness, coma, seizures, and even death. We slowly adjust insulin dosing to avoid this complication, but if your diabetic pet is not responding to you quickly drop honey, maple syrup, or karo syrup on the gums to get some sugar absorbed quickly and then seek emergency care.
• Diabetic ketoacidosis is a life-threatening state where the body has started metabolizing proteins for energy because it can't use the glucose. This happens in untreated and sometimes in under-treated pets. These pets feel ill, may start vomiting, get severely dehydrated, and usually need hospitalization with fluid therapy in order to recover.
• Urinary tract infections are a frequent side effect of diabetes. Because the urine of diabetic cats and dogs will contain sugar when their blood glucose climbs higher than 180, it can allow bacteria to grow much more easily than normal urine. Diabetics also frequently don't mount a good immune response to the infection, so they can't clear the bacteria on their own. These infections can be hard to detect at home when your pet is already drinking and urinating more than usual from the diabetes. Regular urine cultures are the best way to identify these infections and then start antibiotics when needed. 
• Cataracts can occur rapidly in diabetic dogs, and but almost never in diabetic cats. 80% of diabetic dogs will develop cataracts within a year of their diagnosis.  This happens because the glucose in the blood also enters the fluid of the eye, and the excess is converted to sorbitol. Sorbitol then draws water into the lens, disrupting its architecture and causing cloudiness. The lens of the eye eventually appears white and causes blindness in that eye. Surgery is the only treatment to regain vision, and can be performed by a veterinary ophthalmologist once the diabetes is controlled. Anti-inflammatory eye drops should be used once a cataract appears in order to decrease inflammation in the eye from the leaky lens proteins. There is a new topical eye medication called Kinostat under development that may prevent this process, but research is still being conducted.

Despite these complications, the bottom line is that a diabetic dog or cat can still have a good life. They definitely require a lot of extra care for their nutrition and insulin injections, and the early months can be very frustrating until the right type of insulin at the right dose is found for your particular pet. But we find that most diabetic pets can be well managed at home and just need regular checkups to keep them on the right track.

Pumpkins, costumes, and scary skeletons - it's October! Here are some tips so that both you and your pets can enjoy the holiday in style.

Photo credit: Mike McCune www.flickr.com

Pumpkins are for more than pie
Did you know that pets can enjoy eating pumpkin right along with you? It is a healthy addition to food for many pets. Dogs, cats, parrots, many reptiles, rabbits, and small mammals can all benefit from pumpkin.

• Natural remedy for diarrhea or constipation: Pumpkin has a high fiber content that draws water into the colon. This will absorb the excess water from diarrhea to create more formed stool, and soften hard constipated stool to make it more flexible and easier to pass. Start with adding a couple tablespoons of cooked or canned plain pumpkin (not the pie mix) for cats and smaller dogs and 1/4 - 1/2 cup per meal for larger pets, then adjust as necessary.
• Vitamin-filled treat: rabbits, guinea pigs, other small mammals, and many reptiles can snack on cooked or raw pumpkin. If feeding raw, wash thoroughly and cube or shred the flesh to make it easier to eat. Keep quantities small since it can cause diarrhea if suddenly eaten in large quantities. 
• Bird Enrichment: many parrots will enjoy the whole pumpkin inside and out. Wash the outside carefully to remove any pesticide residue (buy organic if you can). Remove the top and cut holes in the side if you want to, then watch your parrot climb and feast. The seeds and flesh can be eaten raw or cooked, just remember not to salt the seeds if you're roasting them. Don't be alarmed if the stool turns orange and is a bit looser than usual after a pumpkin meal.

1 in 3 cats will develop kidney disease during their lifetime. The signs are subtle, and the disease can progress to kidney failure before it's recognized. Thankfully, there are screening tests available to monitor your cat's kidney health, so we can intervene and slow down the disease before your cat ever feels ill.

​The kidneys play a key role in filtering the blood and removing waste products. As their function decreases, those waste products build up in the blood and cause illness. The kidneys are also important in balancing electrolytes. Kidney disease allows important salts and proteins to leak through and be lost in the urine.

How to diagnose kidney disease:
Cats 7 years old and older should have screening for kidney disease done every year, and twice per year after they're 10 years old. This gives us the best chance of catching kidney disease in its early stages, where simple diet change can have a huge impact. If you notice any of the signs of kidney disease in your cat, your veterinarian can run a few simple tests to assess kidney function. We start with a complete physical exam, including palpating the kidneys. Cats with chronic kidney disease often have small firm kidneys. We then run blood and urine tests and check blood pressure.

Blood tests:
The earliest blood marker of kidney disease is SDMA. It can detect as little as 1/4 kidney function loss, well before there are any outside signs of illness.
Creatinine and BUN increase when 3/4 of kidney function is lost.  The cats usually feel ill as these increase.

Urine tests:
Isosthenuria, where the concentration of the urine is the same as the blood plasma, occurs once approximately 2/3 of kidney function is lost. 
Proteinuria, where the kidneys leak protein, requires special additional treatment.
We also evaluate for red and white blood cells, bacteria, abnormal urinary tract cells or casts, and crystals. These can indicate infection or ongoing kidney injury.

Blood pressure:
Cats with chronic kidney disease often develop hypertension. This then causes more kidney injury as the high blood pressure damages the remaining functioning kidney.  We can interrupt this vicious cycle with appropriate medication.

Treating Kidney Disease:
While there's no cure, cats with chronic kidney disease (CKD) can live for years with good quality of life if their disease is managed. Frequent monitoring is the key to success so treatments can be adjusted.

• Look for an underlying cause - infections, toxins, stones, cancer, and other diseases can all have an impact on the kidneys. Sometimes, treating that infection or supporting through the toxin exposure can reverse the kidney disease.
• Adjust diet - kidney-supporting food, like Hill's K/D or Purina NF, have been shown to greatly prolong the lives of cats with kidney disease and decrease the number of hospitalizations. Canned food helps provide additional fluid support.
• Keep fresh water readily available - some cats prefer moving water, like faucets or fountains. Other cats enjoy ice cubes in their water. Try to entice your cat to drink, since it is easy for a cat with kidney disease to become dehydrated.
• Supplements like Azodyl and Epakitin can support kidney function. They come as powders and are easy to add to food.
• Manage blood pressure - medication is used to manage hypertension if necessary. This can be compounded into a cream applied to the inside of the ear or a flavored liquid if your cat doesn't take pills easily. The most common medication is amlodipine.
• Treat urine protein loss - benazapril and enalapril are commonly used to decrease urine protein loss if needed. These can also be compounded to make them easy to give to your cat.
• Manage electrolytes - tasty potassium tablets and gels are available when your cat's potassium level falls, and phosphorus binders can be given with meals when phosphorus levels climb too high.
• Give additional fluids - fluids can be given under the skin to keep your cat better hydrated. It is amazing how much better they feel once they have their fluids, and most cats will let you do this comfortably at home. We can teach you how when the time comes.
• Treat anemia - over time, cats with chronic kidney disease usually develop anemia. This contributes to their feelings of weakness. A bone marrow stimulant like darbepoeitin and iron supplement can be used carefully at this point. We can weigh the pro's and con's when the time comes.

We tailor treatment of kidney disease to the individual cat. This is a disease that we manage over the course of years, and quality of life is the most important. Some cats will permit every intervention while others are happier with a less-is-more approach. By being aware of changes to your cat's routine, you can help us catch this early and find the best strategy for treatment.

August 15 was National Check the Chip Day, so this month we're writing to remind you about the best way to  increase your chances of finding your pet if he or she ever gets lost.

What is a microchip, anyway?

• A microchip is a way to permanently identify your pet.
• It is a small electronic chip enclosed in a glass cylinder.
• It is the size of a grain of rice.
• ​The microchip is not a tracking device. It only contains your pet's unique ID number.
  
• A needle is used to place it underneath the skin, usually between the shoulder blades.
• Your pet can't feel it once it's in place.
• All animal shelters and veterinarians have scanners that can read the ID number on the microchip.
• You keep your contact information up to date in the microchip database.

​Do microchips work?

Yes! A study of stray animals at animal shelters showed that microchipped dogs were more than twice as likely to be returned to their owners as dogs without chips. Cats with microchips were 21 times as likely to be returned to their owners as cats without chips! But even so, more than half of microchipped dogs and cats were never reunited with their owners because the contact information in the database was missing or out of date. 
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Is your pet’s microchip information up to date? Use the AAHA Universal Pet Microchip Lookup to check and see which company your pet’s chip is registered with – then contact the company and make sure they have your correct contact information. http://www.petmicrochiplookup.org/

July 15 is National Pet Fire Safety Day. Every year, nearly 1000 home fires are started in the United States by a household pet. The most common cause is a dog or cat jumping up on a gas stove and turning the knob, igniting whatever is on the stove. One of our own clients suffered this tragedy a couple years ago when his basset hound jumped on the stove to get to a bag of kibble. The firefighters were able to resuscitate the basset, but another dog in the home died in the fire and the house was destroyed. 

 When you're not home:
Keep young pets confined so they can't get into trouble and are easy to find in case of emergency.

Consider leaving pets in rooms close to the entrances/exits of the home so they're easy to rescue. Ideally, your pets should stay in a part of the home with 2 exits so that they are less likely to be trapped.

Since pets can't escape a burning home on their own, consider monitored smoke alarms so that a company can be alerted if the alarms go off, and the fire department dispatched even when you're not home.

​Affix a pet window cling - firefighters must prioritize human lives, but they will usually save pets whenever possible. A window decal with a date and information about the number and type of pets can help rescue personnel be on the alert for your pet family.

Did you know that July 5 is the biggest intake day of the year for animal shelters? Every year the fireworks and celebrations scare dogs and cats and they lose their way. Here are some precautions to make sure your furry friends stay safe at home. All of these tips also apply to pets who are afraid of thunderstorms, too.

1. Keep them secure
All pets should be kept indoors during fireworks, whether they're being exposed to a large municipal show or the backyard noisemakers. It's too easy for a dog or cat to slip a collar, jump a fence, or simply run away when the air is exploding in noise all around them. A quiet basement or a back room away from windows is usually the best place. Provide indoor cats with hiding spots where they can feel safe, and warn children not to try to reach in and try to pet their pal if they've found a dark quiet spot. For outdoor cats, a doghouse or under-deck space usually provides some refuge. Playing music loudly can also decrease the stimulation from the outdoor bangs and pops.

Now is also a great time to double check your pet's microchip - your vet can scan the chip to make sure it works, and you can log in to the manufacturer's database to make sure your contact information is up to date.

3. Supplement for stress
Calming supplements and foods work best when given for several weeks to months, so start now. There can be some effect when given the day of, but the further ahead you start the less panic your pet will feel when the fireworks start. Clinically proven calming foods include Hill's C/D Stress for cats and I/D stress for dogs, and Royal Canin Calm for both cats and dogs.
Supplements Zylkene and Solliquin are both excellent at decreasing anxiety when given daily, and while you may see a change on day 1, they will reach peak effect in 6 weeks. They are based on the milk protein casein, which is one of the factors that promotes relaxation in newborns after nursing.
ProQuiet is a bit less potent than Zylkene and Solliquin, but it's meant to be given several hours before a trigger event instead of every day. It is full of l-tryptophan, the same amino acid that makes us calm after a turkey dinner.

 4. Medicate if needed
There's no shame in needing a little more chemical help for our pets. We can't explain to them that the fireworks will be done shortly, and a safe calming medication prevents the wind-up of fear and adrenaline. Talk to your veterinarian about which medication is best for your pet - there are a number of options, and the treatment plan should be made with your pet's specific health status and fear response in mind. Medications used for situational anxiety include diazepam, alprazolam, lorazepam, and sileo. They must be prescribed by a veterinarian, so plan enough time to have your pet seen for an appointment if needed before getting the medication.

So with these strategies, we can help our pets have a calm, safe 4th of July - and maybe weather the summer thunderstorms a little more easily too.