Trouble with the Litter Box

It is fairly common for owners to bring their cat in because of problems with their cat urinating outside the litter box.  When this happens, it is the veterinarians job to try and determine whether this is a medical or behavioral problem.  Then, after figuring out what the problem is, trying to come up with a treatment plan.

The first step is getting a good history of when, where, how, etc that these accidents are occurring.  An indication that the problem may be medical would be a history where the cat is straining to urinate, producing frequent, small urine spots, licking a large amount at the back area, drinking more or urinating more than usual, or in general not feeling well.  When this is the case we can worry about infections, inflammation, bladder stones, etc.  I will discuss these problems in more detail in a later blog.

Even if the history doesn't quite fit with a medical problem, it may be suggested to perform a medical work-up to make sure that no problems are seen.  This could include basic bloodwork (complete blood count, blood chemistry, thyroid hormone) and then a more detailed analysis of the urogenital system (urinalysis, urine culture, imaging of the urogenital tract with either radiographs or an ultrasound).

If a medical issue is ruled out, then the problem may be more of a behavioral issue.  Behavioral issues can be broken down further into issues involving marking versus litter box training or aversion issues.  An indication that problems with the litter box may be a marking issue would be if the history includes:

1.) Urine spraying on a vertical surface
2.) Problem started after a change in the household (new roommate, new furniture, recent visit from friends/relatives, new pet)
3.) Accidents occur around a window or door
4.) Accidents occur on owner's bed or clothes
5.) Accidents tend to occur in a similar spot
6.) The pet is defecating in the box, but not urinating in the box.
7.) The pet sometimes urinates in the box, but sometimes urinates outside the box

These histories tend to indicate more of a territorial or anxiety issue and the cat trying to assert it's claim on that particular environment.  This is different than a problem with litter box aversion or training issue.  In these situations, the histories tend to include things like:

1.) There was a recent change to the litter box, litter location, or litter type
2.) There was a traumatic experience when our pet was using the litter box before (loud noise, attacked by another pet, etc)
3.) The litter box is dirty or perceived dirty by the pet (there are not enough litter boxes for the number of cats in the house.  We typically recommend one more box than the number of cats that you have)
4.) The cat isn't using the litter box for both urination and defecation
5.) The litter box is covered or in a high traffic area of the house
6.) There is a new pet or another pet or person (small child) bothering the pet when they are trying to go

Depending on which problem is determined most likely, we can then determine a treatment plan.  For territorial issues there are a number of medications that can be tried to help with the problem.  Most of the medications tend to run in the anti-anxiety family and can include amitriptyline, fluoxetine, or buspar.  There are also pheromone treatment options that can sometimes work (Feliway).

In cases where there is a litter box aversion, then the solution is more along fixing the perceived problem with the litter box.  This could include adding a litter box, changing locations, cleaning the box more frequently, or switching back to the previous litter.  In some cases, people have confined their pet to a small kennel with the litter box and once their cat is using the box on a regular basis, they will give them more freedom by allowing in a small bathroom, then small room, then the house.

Urinating outside the box can be a very frustrating issue for both clients and veterinarians.  The important thing to remember is that many times the answer is not straight forward and trying different treatments/solutions may be needed.  Give it time and hopefully the problem will be solved.

My Cat or Dog is What?

Cryptorchidism is a condition where one or both of the testicles are not in their correct position.  Instead of being in the scrotum, they are either in the inguinal canal (where the leg meets the belly) or inside the abdomen.  It is much more common to happen in dogs, but as I recently was exposed to (2 cats in 2 months) it can also occur in cats as well.  I should first explain how this happens and then will discuss what should be done about it and why.

The testicles develop in the abdomen near the kidneys.  In the late stages of the fetus and then after a puppy or kitten is born the testicles make a slow descent from the abdomen, through the inguinal canal (small opening between muscle layers of the abdomen and leg), and eventually into the scrotum where they will live.  The testicle is essentially attached to the scrotum by a ligamentous structure called the gubernaculum.  This structure responds to certian hormones during the developmental life cycle and pulls the testicle to its normal position.  Typically the testes should be out of the inguinal canal at birth and then by six months should have made their way to the scrotum.

In cases where this process doesn't happen, the pet is consider to be cryptorchid.  Why is this important?   The testes are outside the abdomen because they require a lower temperature for proper sperm development.  When you have a pet that is cryptorchid, the sperm development may not occur correctly and you might have a sterile pet.  This typically isn't a problem except with breeding pets.  The other major issue is that testes not in the scrotum are at a higher risk for cancer development.  The condition is also hereditary.  Because of this the recommendation for cryptorchid pets is to have them neutered. 

In the case of the neuter, the testicle may be located any place along the descent of the testicle.  In many cases the testicle can be palpated in the inguinal canal and a small incision over that area is all that is need to perform the neuter.  In other cases where the testicle is not easily found in the inguinal canal, the veterinarian may need to perform an abdominal exploratory to locate the testicle, as it could be any place from near the kidney to right by the inguinal ring. 

If your pet only has one or no descended testicles, don't panic.  We typically give them until 6 months of age to drop and then if they haven't we can perform a specialized neuter to remove them.

Is my pet getting old?

A common question that I get when seeing patients is how old would my pet be if it were a human.  There are a lot of formulas out there that claim to change your pets age into human years.  Many of these do work fairly well, but as far as figuring out an exact human age I wouldn't put huge faith in them.  What I can tell you is that I see many older dogs and cats and have a general rule of thumb when seeing them:

1. For smaller breed dogs (less than 10-15 lbs) I can routinely see 14-15 year old dogs.  I usually start to classify them as senior around 8-9 years of age.

2. Larger breed dogs (>60-70 lbs) tend not to have as long of a life span and I typically start to call them senior around 6-7 years of age

3. Cats can differ, especially between indoor or outdoor cats.  Indoor cat can live a very long time and I see many 16+ year old cats.  I usually classify them as middle age around 7 years and senior after 10 years.  Outdoor cats tend not to live as long, but I usually classify them the same way.

So, why does it matter when your pet gets older?  Well, just like with people, pets tend to develop medical problems as they age.  They might not show outward signs of problems, but bloodwork can sometimes pick up early signs of problems.  This is why we recommend a senior screening examination for pets determined to be elderly.

What does a seniors screening exam involve?

1.  With dogs, after the exam we run bloodwork that includes a complete blood count, a six panel chemistry (looking at liver, kidney, blood sugar, and protein values), urinalysis, heartworm test, fecal floatation test, and eye pressures.

2. Cats are slightly different and along with an exam we perform a complete blood count, six panel chemistry panel, urinalysis, thryoid values, and fecal floatation test

The reason that we run these tests are to screen for medical problems where we might be able to intervene and prevent further damage or manage the diseases successfully.  For dogs, we worry about liver disease, Cushing's disease, kidney disease and these tests help determine whether a problem is present.  With cats, we are looking for signs of kidney disease, hyperthryoidism, diabetes, or liver disease.

If changes are seen on bloodwork, then your veterinarian can recommend further diagnostic tests that should be pursued to better evaluate for what may be going on.  They can then recommend treatment options to help manage problems that are found.

Make sure to ask your veterinarian about your pet's senior health at your next visit.

Trouble Breathing

With selective and successful (or unsuccessful depending on how you view it) breeding in dogs, veterinarians see a lot of congenital problems in pets.  One of the more common problems we see is in short nosed breed dogs (Boston Terriers, Bulldogs, etc) called brachycephalic airway syndrome.  This isn't just one problem, but a combination of problems that can lead to difficulty breathing.

If you talk to the owner of one of these dogs, you likely will hear them describe noisy breathing, snoring, and sometimes gagging; but problems can also become more serious with faining episodes, turning blue, or even death in severe cases.  So what causes these problems?  It all stems from the selective breeding of the shorter or no-nose at all trait.  This has lead to collateral problems; in particular an elongated soft palate, stenotic nares (narrow nasal passage), and hypoplastic trachea (narrow windpipe).  Over time this can lead to negative pressure in the back of the throat, which can cause further damage including everted laryngeal saccules (these interfere with the opening of the airway) and in worst case scenarios laryngeal collapse (complete blockage of the airway).

 

So why is it such a big deal to have these traits?  If the traits are mild, then it may not be a huge deal; however, with extreme cases the traits can interfere with breathing.  As you can see from the above image, the larynx is the area in the back of the throat where two functions connect (breathing and eating).  There is a small structure called the epiglottis that covers the opening of the airway (windpipe) when a pet is eating and drinking to prevent food or water from entering the windpipe.  This should only cover the windpipe during swallowing and otherwise the larynx and windpipe should be open and free to allow air to pass into the lungs.  Dogs with long soft palates have problems because the back of the soft palpate can interfere with the windpipe opening and prevent air from passing into the windpipe and lungs.  The noisy breathing or snoring is from the air being blocked by the soft palate.  The narrow nasal passages also interfere with the movement of air.  Like I said before, in mild cases this is not terrible, but as dogs age or in extreme cases the soft palate can get worse (swollen) and completely obstruct the airway.  This can become life threatening if the pet cannot get this unblocked as they essential suffocate from lack of oxygen.

If the soft palate dose not completely block the airway, over time the back of the throat (larynx) can get worse as the negative pressure placed on the larynx from the narrowed passageway can cause it to weaken and essentially collapse leading to blockage of the airway as well.  In these cases, the only real way we can help is to perform a permanent tracheostomy (make a hole in the neck of the dog that connects to the windpipe) for them to breath through.

Obviously, making a hole in the neck of a pet is not the most ideal.  Fortunately, there are some things we can do prior to this point to help out dogs with serious breathing problems.  We essentially correct the problems surgically.  This typically involves widening the openings of the nostrils to allow more air to move through the nasal passage along with shortening the soft palate to a more normal length.  These procedures are most effective when performed on younger dogs as it prevents pressures from working on the larynx and weakening it.  Many times these can be performed during a spay or neuter procedure, so a second anesthetic event is not needed.

Soft palate after resection. Courtesy of Vet Specialists of South Florida

Although the procedures may not completely rid a pet of noisy breathing, in most cases dogs show considerable improvement in breathing, as well as exercise tolerance.  For more information on this condition, you can visit this link.

Feeding Your Cat

Giving advice on feeding your pet can be quite difficult with so many options available in pet foods these days.  For the most part, many of the diets out there are well balanced and your cat will likely receive the proper nutrition with a majority of the diets that they eat.  I would like to give a few suggestions though when choosing a diet for your cat.

First, a little background on cat's nutritional needs.  Unlike dogs that are omnivores, cats are strict carnivores.  In the wild, they would typically eat small mammals like rabbits and mice, so their protein and fat requirements are high while their need for carbohydrates is low.  When you break down a typical mouse they are around 55% protein, 38% fat, 2% carbohydrates, and the remainder a mixture of minerals and vitamins (with a moisture level of around 65%).  Looking at many commercial diets you may see that they can have carbohydrate loads upwards of 20-30% (which is typically very high for cats) and the dry diets have moisture levels of around 10% (which is very low for cats).

So then, what do I suggest that a cat eat.  First, feeding an all wet food diet or mostly wet food diet is helpful.  This helps a lot with hydration, which is important (especially in male cats).  Many cats can get urinary issues when they are chronically dehydrated and keeping them on a wet diet helps prevent this.  Also, a diet low in carbohydrates (hopefully less than 15%) with a protein level higher than 30% would be ideal.  You can check out this table to see where your pet food stands.  Making sure that the protein sources are from a meat source and not plant source is important as well.  

The other issue is feeding the correct amount of food for your cat.  Most cats only need between 150-250 calories per day of food, which typically comes to around one 6 oz can of food or 1/3-1/2 cup dry food per day.  More active cats will need more food while less active ones need less.  A typical cat is ideally around 12 pounds.

Another good resource for feeding your cat can be found here.

Tapeworms

Although there are a lot more intestinal parasites out there, I am going to finish the discussion of parasites with the last of the most common parasites we see: Tapeworms.

There are numerous species of tapeworms in the environment, but the two most common that we see in pets are Dipylidium and Taenia species. These two species have a slightly different life cycle. Both live in the small intestine and anchor to the wall with mouth pieces in the head of their body. They are composed of multiple, small segments that mature and eventually detach and are shed in the environment in the feces. These segments are around 6 mm in length and look similar to a rice segment. These segments are packed full of eggs, which then go on to complete their life cycle.

Dipylidium eggs are then ingested by the larval stage of a flea. Once the flea matures into an adult, it finds a dog or cat to feed on. When fleas bite a pet, it typically causes an itch response which leads them to lick and scratch. During this licking, pets can often ingest the flea (with the eggs of the tapeworm inside) and then complete the life cycle in the small intestine.

Taenia tapeworms are different in that they don't use fleas to transfer to another pet. After the eggs are shed in the feces, they are ingested by a intermediate hosts (mouse, deer, cow) and then hatch in the intestines. From here, they spread to other parts of the body and encyst in a small sac. The dog or cat then eats the intermediate host, thereby eating the tapeworm stage and completes the life cycle.

Many times you won't see any clinical signs when your pet has tapeworms. With heavy infections, you may see weight loss (even with a good appetite), diarrhea, or rectal itching. Without clinical signs, you may just see the tapeworms segments in the feces and that is all.

Because tapeworms are in a different family of intestinal parasites, they do require a different dewormer than hookworms, roundworms, and whipworms. The typical treatment is with a medication called pranziquantal. Typically only one injection or pill is needed; however, it may be suggested to repeat the treatment in a few weeks, especially in households where fleas are a problem and reinfection is possible.

I hope that these discussions on intestinal parasites were helpful. Please let me know if you have any questions about any of the common parasites that we see. With the warmer weather our next topic will be heartworm disease. Stay tuned.

Whipworms

Another of the common intestinal parasites are whipworms. These are slightly different from hookworms and roundworms in that they live in the large intestines (particularly the cecum) versus the small intestine. Like the other worms, pets pick up eggs in the environment which travel to the stomach, through the small intestine, and into the large intestine. It can take a long time from ingestion of the egg to maturation of the adult worm (75 days) when it can lay eggs of its own. After eggs are passed into the environment in the feces it takes 2-4 weeks for them to become infective, so early pick up of the feces can help prevent reinfection in affected animals.

The adult worms imbed deep into the intestine wall, so with heavy infestations you can see some major problems including chronic diarrhea, blood in the stool, weight loss, and on occasion a syndrome that mimics Addison's disease. That is why annual stool checks for parasites are important.

If whipworms are found, then your pet should be dewormed. Not all dewormers treat whipworms, so it is important to treat with the right kind of dewormer (typically Panacur). Because the whipworm take so long to mature and the dewormers typically only kill the adult worm and not larval stages, deworming multiple times at 3 weeks and 3 months is recommended. It is also recommended to continue on a heartworm prevention that also prevents whipworms (Interceptor) as the eggs persist in the environement for years and reinfection is always possible.

The one good point about whipworms is that they are not readily transmitted to humans, so you do not have to worry about picking up these parasites yourself. Coming up next are tapeworms.

Hookworms

Hookworms are another of the common intestinal parasites that we see in small animals. The life cycle of hookworms is similar to that of roundworms with a few differences. Like the roundworm, hookworms live in the small intestine. They have sharp teeth that attach to and penetrate the intestinal wall where they are able to live off of the blood of their host. While in the intestine the adult worm lays eggs which are then passed out into the environment in the feces. Once in the outside environment, the eggs hatch and larva emerge. It is the larva that is infective to the dog or cat. The larva can enter the host in a couple of different ways: 1.) by being ingested while the pet is sniffing around outside 2.) penetrating the paw pads or skin of the host.

Once inside the the intestines, the larva can grow into an adult worm and complete the life cycle. Other larva may take an additional step of migrating out of the intestines and making their way to the lungs. They are then coughed up and swallowed to complete the life cycle in the intestines.

Just like roundworms, hookworms can also be passed on to unborn puppies and kittens in the placenta. During stressful events like pregnancy, larva that are dormant in the body can awaken and then spread to the puppies in the placenta. They are also passed in the mother's milk, so if puppies are not infected in the placenta they can be infected soon thereafter while nursing.

If left untreated (especially in the young animals) and the infection is heavy enough, infections can lead to malnutrition, anemia, and possibly death. The good news is that the parasite is readily treatable with common anti-parasite medications like Strongid (pyrantel) or fenbendazole. We recommend that all puppies be dewormed at least 3 times spread out every 2 weeks starting around the time they are 4 weeks old.

Similar to roundworms, hookworms can also be transferred to humans (either through ingestion of contaminated soil or penetration of the feet by larva). This can lead to a condition called cutaneous larva migrans where the larva migrate under the skin in infected people. This is why it is important to not only deworm puppies, but to also check an annual poop sample of your pet to make sure they are clear of parasites.

The next parasite up is whipworms. Stay tuned for more information.

Roundworms

Roundworms are one of the most common parasites that we see in dogs and cats. As their name implies, the adult worms are long and round. They live in the intestines (and occasionally) the stomach of pets. It is not uncommon to see worms in the feces of puppies and, if the infection is large enough you, can see animals vomit up the worms.

Roundworms can be transmitted in a number of different ways. In adults, the worms can actually encyst in a few areas of the body and during stressful events (such as pregnancy) can be shed and spread. The worms can be passed to puppies in the uterus as well as in the mother's milk. In addition, animals can pick up eggs outside by coming in contact with infected soil or poop or by eating animals that are carrying a life cycle stage (like a mouse or other rodent).

After being ingested the eggs hatch in the stomach and then larvae migrate to the lungs. The larvae are then coughed up and swallowed where they make it back to the intestines. Here they grow into adult worms. The adults then lay eggs which are passed out in the feces. These eggs can stay viable in the environment for months to years, so infections can be more common than you think. In puppies we typically see some vomiting or diarrhea when they are infected with roundworms. Adults, however, are usually symptom free, which is why we ask that you bring a stool sample in yearly to evaluate for any parasite infections.

The good news is that the parasites are typically very easily treatable. A medication called Strongid (pyrantel) is the most common dewormer that is used to treat roundworm infections. Since puppies have a very high likelihood of exposure through their mother, we do recommend that all puppies be dewormed with Strongid. The first deworming is done around 2 weeks of age and then repeated every 2 weeks for 3-4 treatments. A poop sample is then checked to make sure that the puppy is parasite free.

Although as a veterinarian I am concerned about your pet, another part of my job is to make sure owners are aware of dangers posed to humans. It is uncommon, but roundworms can be transferred to people (typically through inadvertent ingestion of dirt or with curious toddlers eating dirt). Since the human is not the typical host for the worm, these worms tend to migrate throughout the body of a person and can end up in weird places like the eye and the brain. When here they can obviously cause some unwanted problems. Because of this we like to know your pet's parasite status and if positive treat them for the disease to not only keep them healthy, but also keep you at a lower risk of exposure.

In the next few days I will discuss another of the common parasites, Hookworms. Stay tuned.

The Scoop on Poop!

In a normal social environment most people try to steer clear of talking about bowel movements. In the veterinary profession though, we talk about it on a daily basis. There is good reason for this; in particular, intestinal parasites.

Most of us do not go around eating dirt or sniffing around outside, but unfortunately many of our pets do. This leaves them at a particular risk for picking up a number of different organisms. The main worry that we have is your pet being exposed to an intestinal parasite. The parasites that we see most commonly are roundworms, hookworms, whipworms, and tapeworms. These are particularly common in puppies or kittens, where they are passed from mother to puppy or kitten.

I have heard a number of people ask why they need to bring in a sample of their pet's poop. They don't see any worms or their pet isn't having digestive issues, so don't think their pet has a problem. While in some instances you can see actual worms come out when your pet is going to the bathroom, in most cases a pet is not showing any problems but is still harboring organisms in their intestines. This is why we ask that you bring in a poop sample every year, as many times your pet can look healthy, but still have a hidden problem with parasites.

The reason why it is important that we know whether your pet has worms is that over the long term these parasites can cause nutritional deficiencies and sickness, can be passed on to other pets, and more importantly can be spread to humans in the environment. When you bring a poop sample in, we perform a fecal floatation test. This test uses a liquid with a particular specific gravity that separates any parasite eggs from the poop. We then look at the sample microscopically to identify a particular parasite.

After we identify if there is a parasite problem, we can then determine the best treatment for the condition.

Over the course of the month, I will blog about specific intestinal parasites and what clinical signs you may notice in your pet and how we can go about preventing these problems or treating the problem if it is present.

Okay Doc, we got it, so how do we prevent it?

Happy leap year everyone! I was thinking about all of you this morning while driving to work. The announcer on the radio was talking about it being leap year and some people utilize this 'extra day' in the year to take a leap into faith, a new way of living or simply just a day to stand up and say 'today is a new day' and make a refreshing start. Yes, of course, I thought of you all!

Let's take a bright new approach on preventing that horrible dental disease as much as possible and heading toward a brighter, fresher mouth tomorrow! It's a new day!

First of all, I have to say, the only real way to ensure healthy teeth and gums is to brush daily. Brushing is easy but can be time consuming. You also must use an enzymatic dentrifice toothpaste that is geared toward removing the plaque we spoke about earlier. Brushing will not effectively resolve tartar build-up! Start getting your pet comfortable with having your hands in their mouth by starting when they are young, however it is never too late to start. Remember, though, some dogs and cats will just not tolerate brushing. Don't get bit! It is not worth it. Start slowly by getting them used to a piece of gauze or a finger brush and once they are comfortable with that you may upgrade to an actual brush made for your pet. Dental supplies can be picked up easily at any major pet store and even some grocery stores today!

My personal favorite, as an alternative to brushing, is to use a drinking water additive designed for prevention of plaque. C.E.T. is by far my favorite right now. They do change the taste of the water slightly so it may be necessary to slowly introduce the additive. I believe the directions call for a teaspoon per pint of fresh water. You may want to start with 1/8 teaspoon and increase by 1/8 teaspoon increments each week until you are at the full concentration. The solutions do lose potency during the course of the day. I recommend putting the water additive in the morning water and when you go to change it mid-day you can replace it with fresh water. The water additives are great because pets will eat their food and then normally drink water right after. It is like brushing without the hassle.

In addition to the water additives there are dental chews. I love these. My favorite is C.E.T. Hextra Chews. They are impregnated with Chlorhexidine which is an antibacterial. The are available in several sizes depending on your size of dog and are available for cats!

In conjunction with the water additives the chews assist in plaque removal from the molars. It is important for my patients to have both. The rinse washes away and the chew helps break down the more stubborn stuff. In addition chewing is a healthy, normal, often needed behavior for most dogs.

There are a number of products on the market today to assist you in fighting plaque and tartar. They range from brushes and toothpaste to water additives, to treats and chews and even daily diets. The best advice I can give you, regarding the dental health of your pet, is to find a regime that works for your beloved, four-legged family member and be religious about it. If it is something that is done once per month, it will not work for you.

Enjoy the wonderful weather we are having and certainly enjoy this leap day! I hope I have addressed many of your dental questions this month. If you have any further questions do not hesitate to contact one of us and we would be happy to discuss them with you!

Check us out in March to see what we have to say about poop!

What actually takes place during the dental?

So here we are...another beautiful day today! We have discussed dental disease and the ways in which it may adversely affect the health of our pets. Most people do not understand what actually takes place during the dental procedure so I thought we could discuss it today!

A dental prophylaxis is pretty much the same in your pet as it is in you. As you can imagine your pet is not likely sit still in a dental chair for the dental technician to clean his/her teeth. To perform a proper dental pets must be under general anesthesia.

Anesthesia of any kind is generally a risk just as in humans. It is important, before venturing into anesthesia, to have the patient examined by a veterinarian. Often pre-anesthesia blood work to identify any underlying problems or risks that my interfere with anesthesia will be performed.

Now that we have all of that out in the open let us discuss what will actually happen the day of the procedure.

Upon arrival your pet will immediately begin to be prepped for the procedure. This means that blood samples for the pre-anesthesia screen will be obtained, if not done already. Pain medication will be administered so it can get into the system and be effective once the procedure begins. Some patients, on the discretion of the Doctor, will have an I.V. catheter placed for fluid and drug administration before, during and after the procedure. The patient then is bedded down for the time being to rest and relax before the procedure begins.

When it is time to perform the dental the patient is taken out to have the chance to eliminate before the procedure and will return to the surgical prep area. An intravenous injection (I.V.) of anesthesia will then be administered which will make the patient get very, very sleepy. This is similar to having an outpatient procedure completed at the human hospital.

A tube, called and endotracheal tube, is placed in the airway. This tube will protect the airway and will be used to administer oxygen and anesthetic gas during the procedure. The patient is then transported to the dental suite and will lay on a soft pad that circulates warm water to maintain body temperature. The I.V. injection of anesthesia lasts for only about 10-15 minutes and will wear off after the gas anesthesia begins. The gas anesthesia is a very safe gas anesthetic that is processed mainly by the lungs leaving the liver and kidney function relatively unharmed. After the procedure, once the gas is turned off, the pet will wake very quickly.

The anesthesia technician is with the patient during this entire process. An ECG monitor is connected, oxygen concentration probe is attached, a blood pressure cuff is attached and body temperature is monitored. In addition to electronic monitoring devices the technician also monitors manually as to not only rely on equipment. The monitoring parameters are noted on the anesthesia log during the procedure.

The dental technician examines each tooth for pockets around the root. Checks the gums and overall health of the mouth. All abnormalities are noted. The next step is to remove the hard tartar (calculus) with a hand scaler. Once each tooth is cleaned the dental technician will use an ultrasonic scaler that uses ultrasound waves and water to further clean each tooth above and below the gum line. The veterinarian in charge of the case is then called on to examine the oral cavity and will make a decision regarding teeth that need to be removed due to severe disease. The veterinarian will perform the extractions necessary.

Using the scalers on the teeth will create microscopic scrapes on the surface of the teeth which will act as a scaffold for more tartar to form if not corrected. The dental technician will then use a polishing compound (that smells like fresh mint) to polish the surface of each tooth and remove the microscopic scrapes. The mouth is then rinsed well and a fluoride foam is applied to all tooth surfaces and will harden the enamel and hopefully help the teeth maintain their strength. The mouth is then rinsed thoroughly and the patient is transported to the recovery area where the anesthesia technician will stay with them until they are standing, swallowing and alert.

Once the patient is up and around the Doctor will call the owner to inform them of how the procedure went and let them know when the patient can be discharged. It usually takes 2-6 hours for the patient to be awake enough to walk out the door and jump in the car.

Upon discharge the owner will be advised on how to prevent the dental disease from returning so quickly. There are a number of preventatives on the market today and we carry several in our office.

Dental disease is inevitable and some patients may need one professional dental prophylaxis in their lifetime while others could have one every 3 months and still have problems. Just as in people a great deal depends on preventative maintenance of the mouth and also depends on genetics.

Needless to say this is quite a day for your pet but they will come home with a fresh, clean smelling mouth.

If you have further questions or concerns regarding dental prophylaxis feel free to contact us anytime.

"Hey Doc...so how will dental disease affect my pet's overall health anyway?"

Well.....the answer is pretty straight forward and obvious once you really think about it! So, we eat food! The saliva mixes with the food, bacteria grows (I know...yuck right?!) and dental disease ensues. In ourselves (well...I would like to think the majority of us) we brush after most meals or at least twice daily. This not only removes the plaque, changes the pH of our mouth and decreases the growth of bacteria but helps maintain overall health and have fresh breath!

Once the dental disease progresses to Grade II and greater the gum line is affected, small blood vessels are irritated and bleeding is noted. Bacteria can then enter those vessels that are exposed and transported through the body and all of the organs and tissues. Now you will have liver problems, kidney problems, heart problems and more.

Bacteria can grow on the heart valves and result in Endocardiosis causing the heart to not function properly. It is not uncommon for us the examine a pet with bad dental disease and occasionally hear a heart murmur that has developed.

That same bacteria finds it's way into the liver causing hepatitis. We prefer to complete pre-surgical bloodwork before administering anesthesia to pets and often will find elevated liver values as a result of dental disease.

Bacteria is not the only problem that we encounter. Believe it or not we also see patients that are malnuorished due to the fact that it is either painful to eat or often the infection circulating around in the body is making them feel weak and not interested in eating normally.

Contrary to some beliefs, there is not an age that makes a patient too old to have a dental performed. As age ensues other health problems arrise due to the normal 'wear and tear' on the body systems. Anesthesia is not something that is ever approached lightly and it is important to prepare patients with pre-anesthetic bloodwork and fluid therapy during the procedure. Often antibiotics are administered prior to and following surgery.

Don't get me wrong...the best anesthesia is no anesthesia, however times arrive when we have no choice and fortunately we are capable of handling those situations. If you are not comfortable with the idea of anesthesia you should discuss the concerns with your veterinarian. If you are still not comfortable you may want to get a second opinion.

Fortunately there are a number of products on the market today that will help avoid costly and risky anesthesia. Your best plan is prevention, prevention, prevention!

Check back later this month and we will discuss what is actually performed during the dental procedure and why it is necessary to use general anesthesia and ways that we can prevent dental disease in the first place.

Valentine worthy smiles...

As I sit back this afternoon and take in the wonderful warm weather we are having I cannot help to think that I can hardly believe the Holidays came and went. Here we are one foot in the door of February and moving through 2012.

I don't know about you but February always brings warm fuzzies to my heart as I think about Valentines Day and things to do for my lovey this year. It always brings a little smile from inside. Realistically, subconsciously and more likely it has to do with the fact that we have all been being good with our diet and exercise since the holiday indulgence and this is our first opportunity to feed our chocolate addiction.

Oddly enough, as all good veterinarians would, I think of Valentine's Day and smiles, which leads me to think of pets' that smile, which leads me to thinking of teeth and dental health and oddly enough February is National Dental Health Month! Whew, that is a lot of thinking!

I stepped away for a moment to see four of the cutest shih tzu patients I have seen in a while and was asked one of our most common questions in practice, "How are their teeth?". My answer for them and all of you is this...

Dental disease is among us every day. It is in the human world and in the veterinary world. There are two things you will see on teeth:
1.) Plaque: the white, creamy substance found on teeth. Contains saliva, food debris and bacteria. If not removed will turn into tartar (also know as calculus)

2.) Tartar (Calculus): the hard brown cement-like substance formed by plaque that has not been removed. Very damaging to the tooth and surrounding gingival tissue.

In our office we grade dental disease on a scale of 1-4.

Grade I: plaque is present, generally no tartar to speak of and no gingival involvement. The damage at this point IS REVERSIBLE!

Grade II: Plaque, mild tartar and mild reddness of the gingiva (gum tissue around teeth). The damage at this point IS REVERSIBLE!

Grade III: Plaque, moderate tartar, moderate to severe gingival irritation, maybe sores. The damage at this point IS NOT REVERSIBLE!!

Grade IV: Plaque, severe tartar, severe gingival irritation, sores, loose teeth and infection. The damage at this point IS NOT REVERSIBLE!!

All pets with a Grade II or above need to have a professional dental prophylaxis (cleaning) performed under general anesthesia at a veterinary office.

Look at your pet tonight. Did they smile back? Is their halitosis so bad that you cannot stand to go into the room with them?

Check back here this month to see how this dental disease can affect your pet's health and nutrition.

Contact one of our clinics today and ask how we can help your pet smile from the inside out!

Things always come in sets of three...

Veterinarians see a multitude of cases in a day. Anything is up for grabs. It could be a new cuddly puppy or kitten visit or a very sick patient that may not make it and anyting between. That is why I like my job so much! It is always different. I have noticed over the years that one thing never changes. It appears the the old saying, 'everything happens in threes' , still holds strong.

Today I had three patients all limping on their right back leg. All three have had x-rays and, believe it or not, they all have ruptured ligaments in their knees and require surgery to repair. I always have to stop and chuckle when we have three black cats in a row, or three poodles, or three white cats and the list continues.

It is nice to know that even though time seems to fly right by us, we can always count on a few standards to complete our vision of normalcy.

Review of Annual Services

With the new year I thought it would be appropriate to review yearly recommendations for your pets. First off, we do recommend annual visits to the veterinarian for all your pets. Even if your pet is healthy, it is good to have them checked out as your veterinarian may find something out of the ordinary or can discuss preventative care tips with you. Things that will likely be discussed with you at your pets annual visit:

1. Vaccinations: There are a number of vaccinations available for dogs, but the main vaccines that we promote are against Distemper virus, Adenovirus, Parainfluenza virus, Parvo virus, Leptospirosis bacteria, and Rabies virus. For cats, we recommend vaccinations for Calcivirus, Herpes virus, Panleukopenia virus, Rabies virus, and possibly FELV virus (if outdoor). After the initial puppy and kitten vaccine series many of these vaccines can be given every few years, but some are required yearly to be affective. Every clinic is different, so recommendations may vary depending on where you go.

2. Heartworm testing and prevention (dogs): Heartworm disease is passed by mosquitoes and is prevalent in Illinois. We recommend year round prevention along with annual testing. The reason we test annually is that preventatives are not 100% effective (dogs spitting out pills, resistance of parasite to medication), so even with prevention there is still a small risk for a positive test.

3. Fecal floatation: Pets are known for eating things they shouldn't and unfortunately this can include dirt and other pet's feces. Hookworms, roundworms, and whipworms are common in the environment and can be picked up easily. Fortunately, many of the heartworm preventatives also protect against common intestinal parasites. However, there is still a risk of infection, so an annual fecal exam to look for parasite eggs is recommended.

4. Weight evaluation: Just like with people, obesity is a rampant problem in pets. With obesity comes increased risks for diseases such as diabetes, arthritis, heart disease, etc, so it is good to have your pets weight evaluated on a yearly basis. If your pet is overweight, your veterinarian can implement a plan to help get the weight under control. This typically involves recommending changes in diet and exercise. Just like with people, we need to have more calories expended then taken in to promote weight loss. Developing a plan with your veterinarian, implementing that plan, and following up with weight rechecks is important in your pet's weight control.

5. Teeth evaluation: Dental disease is very common in pets. It can range from simple tarter on the teeth to gingivitis to severe periodontitis with loose teeth. We try to prevent the latter by evaluating the teeth annually and getting pets in prior to progression of dental disease. Small breed pets tend to get worse dental disease than larger pets, but dental disease can happen to any pet. Some pets need annual cleanings, while others may need teeth cleaned every few years. To lengthen the time between cleanings in the clinic, we recommend home care of your pet's teeth with daily brushing with an enzymatic tooth paste.

6. Flea prevention: If anyone has every dealt with fleas, they know how much of a hassle they can be. We try to have you avoid this headache by being on an effective monthly preventative. There are a number of choices out there and you can discuss the options with your veterinarian at your annual visit.

In addition to these topics, you can also discuss any concerns or questions you have about your pet. As you can see, there are a number of issues to cover, so please remember to schedule your pet's annual visit to your veterinarian.