August 2018

Almost every pet owner in central North Carolina is aware of heartworms. This dreaded pest is all too common in our area, and can cause significant disease (and even death) in affected animals. Thankfully we have some very good medications that can kill immature heartworms before they can cause disease. Moreover, these medications have additional benefits that make it that much more important to give our pets a heartworm preventative every month. Here are a few facts about heartworms and their prevention:

1. Heartworms are transmitted by mosquito bites. While the mature heartworm lives within (and causes damages to) the heart, immature heartworm larvae float through an infected animal’s bloodstream. Mosquitoes can ingest these larvae as they take their blood meal, and eventually can transmit the heartworm larvae into the bloodstream of other animals when the mosquito takes another meal. Mosquitoes may slow down over the winter, but they do not go away – heartworm prevention is therefore imperative every month where we live.
2. Heartworms are not contagious. Heartworm larvae must live in the mosquito for a while before they can be transmitted to another animal. Nonetheless, heartworm disease is much more common in areas where mosquitoes and unprotected dogs and cats abound.
3. Cats can also suffer from heartworm disease. In fact, the incidence of heartworm exposure in cats is equal to, if not greater than, the incidence of feline leukemia (FeLV) or feline immunodeficiency virus (FIV). Cats may suffer a number of heartworm-related illnesses that can range from a chronic cough to sudden death. And not only can cats develop heartworm disease, there is no treatment available for cats. Please do not be lulled into thinking that your indoor cat is safe from heartworms; in a recent North Carolina study, 28% of cats diagnosed with heartworms were indoor-only. Mosquitoes can and will find their way into your house.
4. Heartworm prevention kills more than just heartworm larvae. Commonly-used medications like Heartgard Plus and Revolution also kill the larvae of a number of intestinal worms, like roundworms and hookworms. Intestinal worms share one characteristic with heartworms – they are endemic to our area. They differ in several other respects, however. Intestinal worms are not transmitted by mosquitoes; instead, intestinal worms produce eggs which pass out of the infected animal when it defecates. These eggs are rather sticky, and attach to other animals’ paws when they walk across ground where infected animals have defecated in the past. The animal then licks its paws, and the eggs are transported to the animal’s intestines where the worms quickly set up residence. This is but one example of the timeless “fecal-oral” route of transmission, which is rather gross but all too common.

Another unpleasant thing about intestinal worms – people can get them. We seem to be pretty resistant to heartworms, but not intestinal worms. If you have a strong stomach, Google the phrase “larval migrans” and look at some of the images. This is not something you want a family member to contract!

I’ve often thought that heartworm prevention should be called worm prevention. It does not prevent every intestinal worm out there, but it does prevent a number of the more common varieties. And so, for both the safety of your pet as well as your family, please be sure your dog or cat receives a good heartworm preventative every month without fail.

One of the interesting things about being a small-animal veterinarian is the variety of tasks we perform. We jump from general practice for wellness exams and vaccines, to internal medicine for ill patients, to dentistry, and to surgery – often all in the same morning. In speaking with clients, I notice that many questions tend to focus on pet surgery: what’s it like? How do you do it? Is it fun, scary, or both?

A surgical procedure at North Hills follows many steps. The first step, which usually takes place before the surgery date, is to discuss the procedure with the client. We talk about the underlying problem, the manner in which surgery may help, post-operative care, and the relative risks and rewards of the procedure. We also prepare an estimate of the costs, which we are happy to discuss with our clients if they have questions.

As many of you know, we ask that you withhold food from the patient on the morning of the procedure. A stomach full of food increases the risk of vomiting, which is one thing we’d prefer to avoid during or after surgery. The patient arrives at North Hills bright and early in the morning, no doubt wondering why no breakfast was served. We examine the patient (we do this even if we had examined the day before surgery) and make sure that heart sounds, breathing, pulse quality, and overall condition are conducive for surgery.

We also usually run blood work to make sure that the patient’s blood counts, electrolyte levels, kidney function and liver function are acceptable for surgery. I say “usually”, because we may not need to repeat blood work if it had been run recently and everything looked fine.

Once the surgeon examines the patient, evaluates blood work and gives the OK to proceed, the patient is given a pre-anesthetic medication that serves to relax the patient and provide some early pain relief. One of our skilled veterinary technicians will then place an intravenous catheter, usually in a front leg. An intravenous catheter serves many functions: it allows us to give medications through the catheter; fluid administration through the catheter helps with hydration as well as blood pressure maintenance; and it provides ready access to a vein in the highly unlikely, but always possible, event that we need to provide emergency assistance to a patient during anesthesia.

The next step is to anesthetize our patient. An intravenous medication is given through the catheter that provides immediate, albeit short term, anesthesia. We then intubate the patient, and use a combination of oxygen and a gas anesthetic to keep the patient under a comfortable plane of anesthesia. Anesthetized patients are monitored in many ways. In addition to the doctor and technician paying strict attention at all times to the patient, we monitor heart rate; oxygenation of blood; pulse; ECG; and blood pressure. We always keep emergency medications and equipment close at hand, and we calculate doses for such medicines prior to surgery.

Then comes the interesting part: the operation! Putting scalpel to skin is daunting at first, but one gets used to it after a while. You’d be surprised at how little an incision into skin bleeds – at least if it is done with a scalpel. Other tissues bleed much more readily. If the sight or smell of blood makes you squeamish, don’t pursue a career in surgery!

People may be surprised at how much movement can occur among abdominal organs. Intestines and spleen in particular can move around quite a bit. People may also be surprised at how visible and tangible many illnesses are. Terms like cancer, pancreatitis or inflammatory bowel disease may seem like ethereal concepts, but in reality they are quite physical and, often, readily apparent.

One of the most time-consuming parts of any surgical procedure involves suturing. If a dog has a large mass under its skin, for example, I can usually remove it in 10 minutes or less. Closure of the incision, however, can take much longer. Proper suture technique involves an approach that allows for both a cosmetic and permanent closure – not always easy to accomplish.

A vital component of any surgical procedure is the post-operative recovery of the patient. We frequently discuss the need to maintain a certain amount of “post-op paranoia” in order to prevent even the slightest lapse in patient monitoring during the recovery phase. It is critical that vet technicians and doctors monitor the patient until it is extubated, conscious, breathing on its own and sitting up in the recovery area.

The last aspect of any surgical procedure involves discussing the outcome and findings with the owner, as well as transcribing our surgical record. If the patient is going home with medication, we will get those ready as well as a summary of discharge instructions.

So, what is it like to perform surgery? It can be daunting the first few times, but one quickly becomes accustomed to it. Surgery also provides a satisfying closure (literal and figurative) that medical cases often do not. With surgery, it either works or it doesn’t.

As with most things, surgical success requires proper preparation beforehand. If the surgeon and staff are well-versed in a procedure, the procedure should be almost routine. I say almost, because pet surgery reminds me of what pilots say about flying: 99% boring, 1% exciting. At North Hills Animal Hospital & Resort, we strive to keep our surgical procedures as boring as possible.

One of the many pearls of wisdom I learned from my anatomy professor in vet school was that cats are not small dogs. It sounds obvious, yet veterinary medicine has often tried to fill the gaps in our knowledge of feline medicine by extrapolating from what we know about dogs. Not surprisingly, that hardly ever works. Cats are different, at times even mysterious… and that’s what makes them so special. Listed below are a few aspects of feline medicine to which the doctors and staff at North Hills Animal Hospital & Resort pay particular attention:

Signs of Illness.

Cats are adept at hiding an illness until it becomes serious. Subtle changes in weight, hair coat, facial expression, appetite and thirst can be the initial, and easily-missed, symptoms of illness. This is one of the reasons an annual examination is so important for your cat.

Cavities.

Cats can get cavities, but it is not from eating too much sugar. Instead, their mouths sometimes take too many minerals away from the teeth, and the teeth slowly dissolve. The medical term for this painful condition is feline odontoclastic resorptive lesion, or FORL. Dogs can do the same, but don’t suffer from resorptive lesions as frequently as cats do. Oral health, including teeth brushing and dental cleanings when needed, is just as important for your cat as it is for your dog.

Exposure to Insects.

We frequently see cats with bald patches on their bellies or legs, and/or with scratches around their faces. We search carefully for fleas on each such cat, and inquire about whether the cat’s owners have noticed any fleas on their pet. In most instances, neither we nor the owners see fleas. And in that case, the most common thing we end up doing is… treating for fleas! Cats are a quandary in this regard: even one flea bite can trigger an allergic skin reaction, but cats are so good at grooming that fleas themselves are rarely found. Another veterinary school pearl of wisdom: in central North Carolina, an itchy cat has fleas unless one can prove otherwise. Sadly, this is true for both indoor and outdoor cats. Indoor cats are protected from many dangers, but are still susceptible to bites from mosquitos and fleas. Our current favorite preventative for cats (and the one I apply to my indoor cat) is Revolution. This monthly topical product can help protect your cat from heartworm disease and fleas, as well as certain mites and intestinal parasites.

Urinary Tract Issues.

Cats can show a variety of symptoms that are consistent with urinary tract infection: straining to urinate, vocalizing, blood in urine, going outside the litterbox, and even urinary tract blockage are not uncommon. But in cats less than 8 years of age, infection is rarely present. Instead these cats are displaying an inflammation of the lower urinary tract that occurs for reasons we do not yet fully understand. The terms used to describe this condition are feline cystitis and feline lower urinary tract disorder. We do know certain risk factors for this inflammation, such as youth, weight gain, dehydration and stress. Young overweight male cats are at particular risk, because the inflammation can cause a life-threatening blockage that must be treated as soon as possible.

Drug Metabolism.

Cats simply do not tolerate many of the medicines we use in dogs or that are formulated for people. And certain medications, such as Tylenol, can be lethal. It is critical to keep all medications out of reach from your cat.

Weight Management.

Maintaining a healthy weight is of course a vital component of health for all mammals. In cats, being overweight can lead to the urinary tract issues described above, arthritis, and diabetes. One of the interesting things about cats is that they frequently lose weight when we switch them from dry food to canned food. It seems counter-intuitive, yet often works.

Behavior.

Cats are partially-domesticated carnivores. Their behavior can be fascinating, mysterious, maddening… and sometimes all three at once. Your cat may not always show it, but she (or he) will benefit greatly from human interaction and a cat tree or other structure that allows your cat to attain an elevation off the floor. Cats also appreciate having a safe place from which they can escape stressors such as other pets, children, guests or loud noises. If your cat spends a fair amount of time under furniture, she is trying to tell you she does not feel safe. This is where a cat tree or other elevated perch, particularly if it is located in a quiet room, can come in handy. Cats also love to play with toys that allow them to act out their predatory nature; however, toys with long strings or ribbons can be fatal if swallowed. The “circle” toys that allow a cat to swat at a ball in an enclosed tube are a fun, safe option for your cat.

Cats are so fascinating that I could go on for several more pages if allowed. We are always happy to work with you to keep your cat happy, healthy and safe!

The​ ​baritone​ ​rumble​ ​of​ ​an​ ​afternoon​ ​thunderstorm,​ ​the​ ​flash​ ​and​ ​bang​ ​of​ ​a​ ​fireworks​ ​display… aren’t​ ​the​ ​sights​ ​and​ ​sounds​ ​of​ ​summer​ ​great?​ ​​ ​Not​ ​if​ ​you’re​ ​a​ ​pet​ ​with​ ​noise​ ​phobia!​ ​​ ​It​ ​is​ ​a​ ​sad fact​ ​that​ ​approximately​ ​20%​ ​of​ ​dogs,​ ​and​ ​a​ ​smaller​ ​percentage​ ​of​ ​cats,​ ​develop​ ​a​ ​genuine​ ​fear​ ​of loud​ ​noises.​ ​​ ​Pets​ ​with​ ​noise​ ​phobia​ ​become​ ​terrified​ ​by​ ​approaching​ ​storms,​ ​and​ ​can​ ​make summer​ ​afternoons​ ​quite​ ​the​ ​ordeal​ ​for​ ​pet​ ​owners.​ ​​ ​Here​ ​are​ ​some​ ​tips​ ​on​ ​how​ ​to​ ​deal​ ​with​ ​this common​ ​issue.

1. Have​ ​a​ ​safe,​ ​secure​ ​place​ ​for​ ​your​ ​pet.​​ ​​ ​Pets​ ​with​ ​noise​ ​phobia​ ​should​ ​have​ ​a​ ​small,​ ​secure, “den”​ ​like​ ​area​ ​in​ ​which​ ​to​ ​stay​ ​during​ ​storms​ ​or​ ​fireworks​ ​displays.​ ​​ ​This​ ​area​ ​ideally​ ​should​ ​be an​ ​indoor​ ​room​ ​away​ ​from​ ​windows​ ​if​ ​possible.​ ​​ ​If​ ​the​ ​room​ ​does​ ​have​ ​windows,​ ​be​ ​sure​ ​they are​ ​completely​ ​covered​ ​to​ ​minimize​ ​the​ ​anxiety-inducing​ ​effects​ ​of​ ​lightning​ ​flashes.

2. Diminish​ ​the​ ​outside​ ​noise.​​ ​​ ​This​ ​can​ ​be​ ​done​ ​through​ ​the​ ​use​ ​of​ ​classical​ ​music​ ​played​ ​over a​ ​stereo​ ​or​ ​a​ ​white-noise​ ​machine.​ ​If​ ​your​ ​pet​ ​will​ ​tolerate​ ​it,​ ​you​ ​can​ ​also​ ​place​ ​cotton​ ​balls​ ​in​ ​its ears​ ​–​ ​just​ ​remember​ ​to​ ​remove​ ​the​ ​cotton​ ​balls​ ​after​ ​the​ ​noise​ ​has​ ​diminished.​ ​​ ​Certain companies​ ​even​ ​make​ ​ear​ ​muffs​ ​for​ ​dogs​ ​–​ ​​Mutt​ ​Muffs​​ ​is​ ​one​ ​such​ ​example.

3. Try​ ​to​ ​divert​ ​your​ ​pet’s​ ​attention.​​ ​​ ​​ ​​ ​Fill​ ​a​ ​​Kong​ ​toy​​ ​with​ ​a​ ​tasty​ ​snack​ ​that​ ​will​ ​take​ ​some time​ ​and​ ​effort​ ​for​ ​your​ ​pet​ ​to​ ​get​ ​out​ ​of​ ​the​ ​Kong.​ ​​ ​Banana,​ ​dry​ ​kibble,​ ​and​ ​peanut​ ​butter​ ​are good​ ​options.

4. Try​ ​over-the-counter​ ​calming​ ​agents.​​ ​​ ​No​ ​agent​ ​is​ ​100%​ ​effective​ ​at​ ​calming​ ​pets​ ​with noise​ ​phobia.​ ​​ ​Nonetheless,​ ​some​ ​pets​ ​do​ ​seem​ ​to​ ​feel​ ​better​ ​with​ ​the​ ​use​ ​of​ ​the​ ​following:

• Thundershirt​.​ ​​ ​This​ ​wraps​ ​snugly​ ​around​ ​your​ ​pet’s​ ​body​ ​and provides​ ​a​ ​swaddling sensation​ ​that​ ​some​ ​pets​ ​find​ ​comforting.​ ​​ ​A Thundercap​​ ​also​ ​exists​ ​to​ ​minimize​ ​visual​ ​stressors like​ ​lightning flashes.
• Adaptil​​ ​for​ ​dogs,​ ​or​ ​​Feliway​​ ​for​ ​cats.​ ​​ ​These​ ​products​ ​are appeasing pheromones​ ​that​ ​can​ ​help​ ​alleviate​ ​your​ ​pet’s​ ​stress​ ​in​ ​a number​ ​of​ ​situations.​ ​​ ​The​ ​products come​ ​in​ ​a​ ​variety​ ​of​ ​forms: plug-in​ ​wall​ ​diffusers,​ ​sprays​ ​and​ ​collars​ ​are​ ​available.
• ​​Zylkene​.​ ​​ ​This​ ​is​ ​a​ ​natural​ ​calming​ ​agent​ ​that​ ​can​ ​help​ ​with​ ​pet anxiety​ ​in​ ​general.​ ​​ ​It does​ ​not​ ​work​ ​immediately,​ ​so​ ​must​ ​be​ ​given on​ ​a​ ​daily​ ​basis.

5. Desensitize​ ​your​ ​pet​ ​to​ ​loud​ ​noises.​​ ​​ ​Purchase​ ​a​ ​CD​ ​of​ ​storm​ ​noises,​ ​and​ ​play​ ​it​ ​on good-weather​ ​days.​ ​​ ​Play​ ​it​ ​quietly​ ​at​ ​first,​ ​then​ ​gradually​ ​turn​ ​up​ ​the​ ​volume.​ ​​ ​Do​ ​not​ ​play​ ​the CD​ ​on​ ​days​ ​of​ ​potential​ ​stormy​ ​weather.

6. Do​ ​not​ ​reward​ ​your​ ​pet’s​ ​anxiety.​​ ​​ ​It​ ​is​ ​natural​ ​to​ ​try​ ​to​ ​comfort​ ​your​ ​pet​ ​when​ ​it​ ​is​ ​stressed. However,​ ​our​ ​efforts​ ​to​ ​alleviate​ ​the​ ​situation​ ​by​ ​giving​ ​attention,​ ​food,​ ​kind​ ​words​ ​and​ ​petting only​ ​serve​ ​to​ ​reward​ ​our​ ​pets​ ​for​ ​being​ ​anxious.​ ​​ ​Similarly,​ ​do​ ​not​ ​try​ ​to​ ​reprimand,​ ​correct​ ​or punish​ ​your​ ​pet​ ​for​ ​its​ ​anxiety.​ ​​ ​Treat​ ​loud​ ​noises​ ​as​ ​no​ ​big​ ​deal.

7. Medications.​ ​​ ​​We​ ​do​ ​sometimes​ ​use​ ​​prescription​ ​medications​​ ​to​ ​help​ ​with​ ​noise​ ​phobia.​ ​​ ​It​ ​is important​ ​to​ ​note​ ​that​ ​medications​ ​alone​ ​are​ ​not​ ​the​ ​answer,​ ​and​ ​also​ ​have​ ​the​ ​potential​ ​for adverse​ ​side​ ​effects.​ ​​ ​Nonetheless,​ ​some​ ​pets​ ​may​ ​receive​ ​an​ ​additional​ ​benefit​ ​from​ ​medications such​ ​as​ ​the​ ​following:

• Clomipramine​:​ ​an​ ​anti-depressant​ ​medication​ ​that​ ​can​ ​be​ ​given​ ​daily​ ​during​ ​the​ ​storm season​ ​to​ ​help​ ​with​ ​noise​ ​phobia.
• Alprazolam​​ ​(generic​ ​for​ ​Xanax):​ ​an​ ​anti-anxiety​ ​medication​ ​that​ ​can​ ​be​ ​given​ ​as needed.​ ​​ ​However,​ ​it​ ​will​ ​be​ ​of​ ​no​ ​use​ ​unless​ ​it​ ​can​ ​be​ ​given​ ​well​ ​before​ ​your​ ​pet​ ​becomes​ ​aware of​ ​an​ ​approaching​ ​storm​ ​or​ ​the​ ​sound​ ​of​ ​fireworks.​ ​​ ​It​ ​also​ ​has​ ​the​ ​potential​ ​to​ ​cause​ ​certain​ ​pets to​ ​act​ ​out​ ​in​ ​ways​ ​they​ ​ordinarily​ ​would​ ​not​ ​do.

Working​ ​together​,​ ​we​ ​can​ ​help​ ​minimize​ ​the​ ​stress​ ​your​ ​pet​ ​experiences​ ​from​ ​loud​ ​noises,​ ​and make​ ​the​ ​summer​ ​a​ ​better​ ​season​ ​for​ ​all​ ​of​ ​us.