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.

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. 

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. 

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.

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.