When is a mosquito bite more than just an itchy annoyance for your dog, cat, or ferret? When that mosquito is carrying a parasite called heartworm (Dirofilaria immitis). Found in all 50 states but most prevalent in the South and Midwest, heartworms are transmitted from one pet to the next by a mosquito.
Heartworms start as tiny microfilaria that can only be seen under a microscope. Over the next 6 months they lodge in the vessels of the heart and lungs and grow to be over a foot long. Adult heartworms can live in your pet for up to 7 years, and create thousands of baby heartworms that will be transmitted to other pets through new mosquitoes.
Heartworm disease is the syndrome caused by these worms living inside your pet. At the beginning, your dog will not show any signs of illness. Early signs of illness can include decreased activity, decreased appetite, weight loss, and/or mild cough. Over time, the heartworms can cause heart failure, kidney failure, or sudden death. Cats and ferrets can get severe disease from just a couple worms, and unfortunately there is no treatment for heartworm in these pets.
Dogs can be treated for heartworms with a medication called immiticide. This kills the adult heartworms and then your dog's immune system will gradually break down the worms. Treating heartworm is a very time-consuming and expensive process. It must be done gradually, because the dead worms can cause potentially fatal clots. Your dog is absolutely NOT allowed to run during the months of treatment because exercise can dislodge a worm and cause sudden death. In order to decrease this risk, we start with a month of an antibiotic to weaken the worms prior to the immiticide and steroids to decrease the inflammation in the lungs following the American Heartworm Society Guidelines.
So, that's all the bad news. What's the good news?
The good news is that heartworm disease is completely preventable. There are many preventive medications available that stop the baby heartworms from developing into adult disease-causing worms. Adding in mosquito repellent provides another layer of protection.
COVID-19 has swept the globe and changed our lives.
The novel coronavirus SARS-CoV-2 originated in a wild animal market in China in December 2019 and has rapidly traversed the globe, causing over 2 million human illnesses to date. Many countries have implemented stay-at-home orders to distance us from each other to slow the transmission and save lives. For some pets, this is the best time of their lives. They have you home all day and are getting all the extra attention and playtime they've always wanted. For others, they are overwhelmed and desperately in need of their mid-day naps. They sense our anxiety but can't understand the cause. So first, take a moment to pause and observe your pets' behavior. If you see signs of stress - lack of appetite, pacing, panting, destructive behaviors, change to play, loss of training - follow these tips to soothe your pet.
Can pets get COVID-19?
Research is ongoing, but at this time there is no evidence that our pets can get seriously ill from this coronavirus. The virus that causes Covid-19 can infect cats and ferrets, but this is only happening rarely. The tigers and lions at the Bronx Zoo in New York displayed mild respiratory signs after their exposure from an asymptomatic person who had contact with them. Researchers have also shown that cats can spread the virus to other cats, but at this time there is no evidence that a cat can give the virus to a person. So there is no reason to isolate yourself from your cat or ferret during this pandemic. (Update 5/7/20 - there are a couple dogs who have also tested positive for Covid-19 and displayed mild respiratory signs. So far the dogs do not seem to be contagious to other dogs, nor are they able to spread it back to a person.)
If you are well, continue to interact with your pets just as you normally would, practicing good hygiene and handwashing.
If you are ill with Covid-19, it is prudent to ask another person to take over care of your pet. This is mostly because your pet can act as a vector to carry the virus to another person. If you have a service animal or are the sole caretaker, avoid kissing or hugging your pet while you are ill. Wash your hands before and after feeding or interacting with your pet and wear a facemask to limit the spread of virus particles when you cough.
More information can be found at these sites:
Covid-19 FAQs for pet owners from the AVMA
For human health:
The State of Ohio's coronavirus page
The Center for Disease Control Covid-19 page
The novel coronavirus outbreak has many people worried for their health and the health of their families and pets. Concerned owners in China have even started putting face masks on their cats when outdoors to minimize the risk of exposure. Should you be worried about your pet? In a word, no.
The current outbreak is caused by a novel coronavirus named Sars-CoV-2, that causes a disease known as COVID-19. As of February 18, the World Health Organization reports it has infected over 73,000 people and caused almost 1900 deaths. That's a lot of people, but let's put it in perspective: the CDC estimates that there have been at least 26,000,000 (yes, million) cases of influenza since October 2019 and at least 14,000 deaths this season here in the United States alone. Companion animals like cats and dogs don't become ill from COVID-19, but it is conceivable that they could carry the virus from one person to another. So a person infected with COVID-19 should minimize contact with their pets to protect other people in the household.
The best protection against viruses is to wash your hands frequently, avoid touching your nose and mouth, and use alcohol-based hand sanitizers after touching public objects (like doorknobs). Stay home if you are ill, and if you are coughing or sneezing in public cover your nose and mouth with a tissue or your elbow to minimize the spray.
But what about other coronaviruses?
Dog Coronavirus Infections:
Cat Coronavirus Infection:
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.
Thankfully, there are several things you can do to make your cat's hairballs less frequent.
- Brush your cat. Less loose hair = less hair ingested = less hair to vomit up. Long-haired cats afflicted by hairballs will benefit from being shaved.
- Feed a hairball-specific diet. Science Diet Hairball Control, Purina Proplan Hairball Management, and Royal Canin Hairball Care cat foods all use proprietary fiber blends to catch the hair and pull it through the GI tract so it can be passed in the stool rather than vomited back up.
- Use a hairball remedy. Laxatone by Vetroquinol is a tasty gel that comes in tuna and maple flavors. It acts as a lubricant that coats the hair and allows it to pass through the GI tract
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.
- Viral upper respiratory infection - this is the most common cause of acute (rapid onset, short term signs), especially in shelters, boarding facilities, and outdoor cats. Herpes and calici viruses are the most common causes and are both highly contagious. Nasal discharge is bilateral, can be clear or white, there is often eye involvement, and it can be accompanied by fever. Signs will usually clear in 7-10 days, but cats can become chronic carriers and spread the virus to other cats.
- Bacterial infection - bacterial infections are often secondary to another cause (like a foreign body or mass), but can also occur on their own. Chlamydophila, mycoplasma, and bordetella can all cause nasal infections. They usually show up with thick green/yellow discharge from both nostrils.
- Allergies - environmental allergies can cause sneezing in cats just like in people. Molds, pollen, and dust mites are the common triggers. Nasal discharge is usually bilateral, clear, and watery. Anti-histamines like chlorpheniramine can help relieve symptoms.
- Fungal infection - less common in Ohio than in the Southwest, cryptococcus infections can cause severe destruction and remodeling of the sinus, leading to facial asymmetry. Affected cats will have thick and sometimes bloody nasal discharge, and often only one nostril is affected.
- Foreign object - cats can inhale grass awns, seeds, or bits of plant material. Acute onset severe sneezing, pawing at the face, and unilateral nasal discharge are signs that something could be stuck.
- Dental disease - tooth root abscesses can breach the nasal cavity and lead to nasal discharge and sometimes bloody noses. This is usually unilateral, and the discharge is usually thick and green/yellow.
- Polyps - polyps are benigns growths that can cause severe nasal discharge from secondary infections. Discharge is usually unilateral and thick green/yellow. Young cats are the most commonly affected. The polyps can grow toward the ear as well. They will often cause congested breathing sounds.
- Cancer - older cats can develop cancer within the sinuses or nasal turbinates that leads to nasal discharge and facial asymmetry. Usually the discharge is unilateral, and it can sometimes be bloody.
- Idiopathic - there are some cats with chronic (long-standing) disease for whom no cause can be found. It is possible that early episodes of viral or bacterial infection remodeled the nasal turbinates or sinuses and predispose these cats to inflammation throughout their lives. While they can rarely be cured, signs can usually be managed to the point that these cats are comfortable and living well.
- 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
- 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.
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.
Core Vaccines for Dogs
Core Vaccines for Cats
Noncore Vaccines for Dogs
Noncore Vaccines for Cats
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.
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.
- Ticks can be tiny. A nymph deer tick is the size of a poppyseed, and can easily hide in fur, hair, or under jewelry.
- 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.
- 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.
- 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.
- 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.
- 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).
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.
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.
The red circles show where bone is missing due to infection. The green line is the gumline - only the lower part of the picture is actually visible to the naked eye. So that's why teeth are like icebergs - what you can see is only a small part of the whole tooth. And just like icebergs, the problems usually lurk under the surface.
Notice how much root there is underneath the gum line! Truffle's bone should be bright white all the way around, but instead she has darker grey and black areas where the bone is missing.
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.
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.
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.
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
Diabetes mellitus (DM) is a common disease in the United States, and it's not limited to people. Both dogs and cats can become diabetic, so here's what you need to know.
1. There are 2 types of diabetes, and they both affect insulin. Insulin is a hormone produced in the pancreas that regulates the amount of glucose in the blood. Cells need insulin in order to absorb the glucose they need for energy.
- increased thirst
- increased urine production, sometimes leading to house-soiling
- increased hunger
- weight loss (especially the back muscles, even if the belly is still large)
- weakness or lethargy
- white-appearing eyes (diabetes often leads to cataracts)
- poor skin or coat condition (flakes, dandruff, or greasiness)
3. Diagnosing Diabetes
If your pet is showing any of these signs, blood and urine tests can make the diagnosis of diabetes and rule out complications that require hospitalization before starting insulin at home.
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.
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.
- 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.