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

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.

​Most young animals who have seizures do not have a specific cause, but it's important to rule out all the diseases listed above so that we can treat them if possible. We call these dogs and cats epileptic. 

Most seizures are not actually dangerous to your pet. Dogs with epilepsy who have seizures lasting less than 5 minutes and occurring less than once per month don't usually require medication. We use medications for pets with clusters of seizures, long seizures, frequent seizures, or long side effects after a seizure (like temporary blindness). Medications like potassium bromide, phenobarbital, and levetiracetam can be used to prevent the seizures. Valium is often given in emergencies to stop an ongoing seizure. Some patients can also respond to nutritional management (Purina ProPlan Neurocare) and/or adding in supplements based on cannabis developed specifically for pets (but do not give human cannabis to pets!). 

All graphics gratefully reprinted with permission from www.canna-pet.com

Oh no! You just got home and your dog or cat has diarrhea. Don't panic - follow these 3 steps to get some relief after you clean up the mess.

1. Take a good look at your pet and around the house.
Think about anything new or different that Fuzzy might have eaten in the past 24 hours. If you gave a new treat or opened a new bag of food, go to step 2.
See anything potentially toxic or poisonous? Call Poison Control asap and follow their recommendations for care.
If your dog or cat is bright and happy besides having diarrhea, proceed to step 2.
Call the vet right away if:

• your pet is quiet or lethargic 
• not interested in toys or treats 
• there's vomiting with the diarrhea
• the diarrhea is severe and watery and lasting more than 2 hours

2. Don't feed. 
This GI tract is on overdrive right now and any new food is going to shoot straight through. Hold off food for 12-24 hours to give those guts a chance to rest. Make sure to keep water available at all times.  

3. Reintroduce bland food.
Once 12-24 hours have gone by offer a small amount (1/4 of the normal food volume) of lean protein (cooked chicken, cooked ground beef with the fat drained off, scrambled eggs) and an easily digestible starch (canned pumpkin, cooked sweet potato, cooked rice).  A spoonful of plain yogurt on top can add in some probiotics. If that doesn't trigger any diarrhea, offer a larger volume of food 6-12 hours later and then continue to feed twice daily. Once the stool firms up, gradually mix your bland food with the original diet and slowly transition your pet back to their regular diet. Note - this diet is not complete and balanced, so should be used short term only. There are several complete and balanced diets like Hill's I/D formula for dogs and cats with GI problems that are safe for long term use.

When to seek veterinary help:

• if the diarrhea lasts more than 48 hours
• if the diarrhea is black and tarry (like coffee grounds) - this can mean a GI bleed
• if your pet starts acting sick - not playing and/or not interested in food
• if there's vomiting
• if your pet is losing weight 

What about human medications?
Some websites recommend giving PeptoBismol or Immodium to dogs with diarrhea. These can be safe to use in certain dogs (not for cats!), but always call your vet first. PeptoBismol contains an ingredient that can cause GI bleeding and turns the stool black, which then masks the bleeding. Immodium can be helpful at slowing down the diarrhea, but dogs with diarrhea from a toxin should not take it because it causes the toxin to stay longer in the body and potentially do more harm. Also, it is not safe to give immodium with certain other medications, so call your vet first.
Probiotics are safe to use in both dogs and cats with diarrhea. Proviable and FortiFlora are made for dogs and cats, and are extensively tested and researched. Equine Probios gel is a good source of probiotics for pet rabbits. 

Some cases of diarrhea can be mild and managed at home with these steps.  For severe watery diarrhea or diarrhea that persists, seek veterinary care for the most rapid relief for your pet. 

Nothing is more frustrating than finding smelly cat urine on your furniture. Here are 3 tips to keep your feline friend peeing and pooping in the litterbox. 

1. Rule out medical problems

• Male cats who strain to urinate can be blocked, a life-threatening EMERGENCY
  • seek veterinary care immediately if your cat is trying to urinate but can't pass urine
• Increased thirst or increased urine volume can be caused by kidney disease or diabetes
• Bloody urine can be caused by cystitis, bladder stones, or rarely bladder wall tumors
  • Cystitis is the most common urinary problem in cats and the bladder wall becomes very painful, inflamed, and bleeds. It can be related to stress and often waxes and wanes with time. Prescription diets (low mineral, calming) and changes to the home environment can help (think high cat trees, hiding spots, plug-in pheromones like Feliway, and structured play sessions)
• Arthritic cats can have trouble climbing stairs or getting into high-walled boxes
• Spraying urine on vertical surfaces can be a marking behavior - neutering and decreasing inter-cat conflict can help

• Urinary tract infections in cats are actually extremely rare

2. ​Make it available

• Have 1 more box than you have cats (so a 2 cat household should have 3 boxes)
• Place the boxes in different rooms, and on different floors if available - this allows older cats access without having to climb stairs, and prevents one cat from guarding the box from another cat
• Most cats prefer unscented, clumping litter
• Provide large open boxes (covered boxes can smell like a portapotty) - your cat needs enough room to comfortably enter the box, turn around, and posture. For large cats, the under-bed storage bins make great litterboxes
• Consider litterbox location - some cats are sensitive to noise and prefer a quiet, low traffic spot

​3. ​Keep it clean

• Scoop the litterbox daily
• Empty the litterbox entirely and clean with warm water and soap once weekly
• Use plastic floor mats under the box for easy clean up if your cat likes to kick the litter over the side
• Fashion cardboard "walls" by propping a piece of cardboard vertically inside the box if your cat likes to urinate out the side - make sure to replace when soiled to decrease odor
• Clean soiled areas in the home with enzymatic deodorizing cleansers to decrease re-soiling the same area. Many cats don't like the feel of aluminum foil under their feet, so laying foil down over the area can decrease repeat accidents
  
• Block access to known accident locations - pick up laundry baskets and keep doors closed if needed to either separate cats who don't get along or prevent resoiling a particular room (make sure your cats' food, water, and box are accessible though!)
  

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Following these tips and treating any medical problems can greatly decrease the chance of your cat peeing or pooping outside the box - and make your home a happy place for both you and your cat!

Dog owners be aware: there's a new outbreak of canine flu slowly spreading towards our area. We were last hit with the H3N2 canine influenza in the summer of 2015, and many dogs were sickened with severe breathing problems. 

What it does:
Flu can cause a lengthy illness that can vary from mild coughing and sneezing to full blown pneumonia requiring hospitalization and oxygen therapy. Most dogs initially get very lethargic with little appetite, then the coughing and sneezing show up a day or two later.  

How it spreads:
The virus is highly contagious dog-to-dog, and cats are susceptible as well. We can accidentally bring the virus home to our pets through our hands, clothing, and shoes. Dogs can shed the virus for several days BEFORE they show any signs of illness, so it's impossible for even the most responsible owners to prevent contact. Once the dog becomes ill, they will shed the virus intermittently for the next 3-4 weeks and are contagious during that time.

Signs of kidney disease:
Increased thirst and increased urine production are the hallmarks of kidney disease. In this stage, as long as your cat drinks enough water to keep herself hydrated she probably doesn't feel ill at all. As the disease progresses, however, the toxins that the kidney normally clears will build up in her bloodstream and make her feel sick. She can experience decreased appetite, weight loss, muscle loss, lethargy, vomiting, and sores in her mouth.

Early diagnosis is the key to your cat living a long and healthy life. Bring your cat in for yearly exams (and twice-yearly if 10 years old or older) so that we can help catch this process before she feels sick. A physical exam allows us to feel for changes in her kidneys, urinalysis looks for protein loss or dilute urine, and bloodwork checks for markers of kidney function. We recommend the new SDMA test for every cat over 7 years old as part of the annual bloodwork because it's the earliest indicator that something is changing in those kidneys. If we do find abnormalities in the lab work, we may recommend x-rays of her abdomen or an ultrasound to look for other possible causes that need different treatment.

What can I do?
Unfortunately, there's no proven way to prevent kidney disease in cats, and the loss of kidney function is often irreversible once it occurs. Offering canned food and encouraging water consumption with water fountains or faucets will help keep our cat companions hydrated, decreasing the stress on the kidneys throughout their lives.

Once we start to see changes in the kidney function the most important intervention is diet change. We need to feed the right amount of high quality protein to protect her muscles but not so much that it taxes her kidneys. There are several brands of prescription foods available, so we let the cat pick the one she likes best. Depending on the amount of protein being lost through her kidneys, we may also add in daily medication at this early stage. Later in the disease we supplement fluids to keep her hydrated, and use appetite stimulants and antacids to decrease the nausea.

With proper management, cats with kidney disease can live happy lives often for years after their first diagnosis.  With this knowledge and the right interventions you can help slow down the progression of the kidney disease and give your cat far more time before she even knows she's ill.

1. Car-sickness: Anxiety combined with motion sickness in a car can cause some cats to drool profusely. Anti-nausea medications before a car-ride can help make the ride more pleasant for your cat.
2. Dental disease: Drooling can be a sign of oral pain caused by bad teeth. Many cats suffer from resorptive dental disease, which is seen as a red line where the gums meet the teeth. This painful condition can only be cured by extracting the affected teeth.
3. Trauma: Injury to your cat’s face or jaw can cause fractures, which lead to drooling if your cat can’t close his or her mouth properly.
4. Foreign objects: Our curious felines like to investigate their world with their mouths, so they commonly get fish hooks or sewing needles stuck in their mouths. Sudden drooling can be a sign of a trapped object.
5. Toxin exposure: Cats are sensitive to a number of plants and household chemicals. They can get ulcers in their mouths when exposed to these substances, which then causes drooling. If there’s any chance of exposure, call Animal Poison Control at (888) 426-4435. Try to coax your cat to drink water or diluted chicken broth or tuna juice to flush out his or her mouth if the exposure was recent, and seek veterinary care. 
6. Kidney failure: Kidney disease affects 1 in 3 cats, usually later in life. As the disease progresses, the kidneys can no longer keep up with normal body metabolism and toxins build up in the blood. These can cause ulcers in the mouth, which cause drooling. Kidney disease can also make your cat feel nauseous, which can sometimes manifest as drooling.
7. Cancer: Cats can grow tumors in their mouths that change their shape and ability to chew. Bad breath, drooling, and changes to eating habits are all signs of oral tumors. 

As you can see, there are many reasons why your cat might be drooling. The first step is a thorough veterinary exam. Before the appointment, look around carefully for any possible toxins (cleaners, household chemicals, plants) that your cat may have ingested. Labwork, x-rays, dental procedures, or biopsies may be needed depending each individual case. Drooling in cats is never normal – let us help your feline friend.

Photo credit: Rocky Mountain Feline Rescue www.flickr.com