Ask Anything: 10 questions with Veterinarian Dr. Page Wages

Dear Donna, there are a lot of flea prevention products on the market today for your dogs and cats. In general, those available only through your veterinarian are the safest products. Many cats and some dogs are very sensitive to the ingredients in the over-the-counter products, such as those available in the supermarket or Walmart. I recommend avoiding these products all together.

It is also recommended to use a product that contains tick prevention as well with any pets that are exposed to the outdoors. While fleas are a very common problem in this area year-round, the ticks are also problematic and carry very serious diseases, such as Lyme, Rocky Mountain Spotted Fever, and Ehrlichia.

For cats, my recommendations for prevention are as follows:

For dogs, my recommendations for prevention are the following:

** During the summer months, I recommend using one of the topical preventions every 3 weeks, instead of every 4 weeks, since the products are their weakest during the last week and in this area, the flea and tick population is very large and challenging to prevent problems**

** With my own pets, I rotate between using the Frontline and Advantix to ensure a resistance within the skin does not develop**

I hope this information is helpful as you make your decision with finding the appropriate prevention for your pets!

Dear Jill, This is a loaded question for sure! Pets are definitely getting more and more care, I agree. However, because of the greater level of care, we are seeing pets living longer, happier, healthier lives! There isn't a specific regime to follow for every pet, since all pets are different, it is best to talk to your veterinarian about tailoring an appropriate plan for preventative care for each of your pets. However, there are some general guidelines I follow in making recommendations to my clients.

Routine dental care is also an important part of maintaining your pets health, very similar to health in people. Some breeds require dental cleanings more frequently than others.

Preventative care, such as flea and tick prevention, and heartworm prevention as well as an appropriate diet will lengthen your dog's lifespan tremendously.

**Some breeds are predisposed to health problems. Talk to your veterinarian to determine what are some common diseases that can be prevented or monitored for in your pet's breed**

**The age guidelines vary depending on the size of the dog. In general, the smaller breeds of dogs typically have a loner lifespan. However, it is no longer uncommon to see Labrador Retrievers live to be 16 or even 18!

Cats are mostly the same, in terms of the recommended guidelines. There are some of the specialty breeds that are more predisposed to the development of diseases at an earlier age and monitoring should be tailored according to your veterinarians' recommendations.

Routine dental care, as needed is recommended. Some cats are predisposed to having gingivitis and routine dental cleanings, if recommended by your veterinarian, will help prevent this from becoming a serious problem.

Routine preventative care, such as flea and tick prevention, as well as heartworm prevention, are also important. **Keep in mind that a large percentage of heartworm positive cats are strictly indoor cats**

Sometimes, just a diet change can be recommended.

In general, the sooner a problem is caught, the easier to treat, and the more prolonged the life of the pet with a higher quality of life. Preventative care is really important. Adding a glucosamine chondroitin supplement as pets age to prolong the onset of arthritis is a good thing.

Vitamins, such as Pet Tinic or Pet Tabs are a good idea as well as your pet ages. Talk to your veterinarian about the recommendations for your pet.

Finally, I can't stress how important a good diet is for your pet. (These are all things that are stressed in human health care as well!) Choose an appropriate diet for your pet based on your pet's needs. Talk to your veterinarian to determine what those needs are, to ensure the appropriate diet choice.

Dear Cindy, I am a firm believer that dogs dream. Just like people, the canine sleep cycle is very similar, with a period of deep sleep in which the body is dreaming and have perform physical activity, such as running or even groaning.

Dear Colleen, My recommendation for puppies and kittens is that they be spayed/neutered between 4-6 months. About 6 months, many animals can start their heat cycles. Female dogs and cats spayed after they go into heat are at a greater risk for the development of a mammary cancer later in life.

This is why we recommend having the procedure done earlier rather than later. Male dogs and cats neutered prior to sexual maturity helps to prevent the development of bad behaviors. Intact male cats have a greater tendency to mark in the house (urinate inappropriately), roam, fight more.

Intact male dogs have a greater tendency to roam and show aggressive tendencies.

Most dogs receive their last vaccination at 5 months of age. I typically recommend getting the last vaccine and the spay/neuter procedure at the same time, to save the owner a trip to the veterinarian. Cats are usually done with their kitten vaccines between 4-5 months, again a perfect time to have your kitten spayed/ neutered.

Hope that helps set the record straight!

Dear Amanda, Anxiety in dogs is not an uncommon problem and can develop at any age. Typically, those dogs with an unstable social past can develop social anxiety.

Most dogs with anxiety benefit both from training with a professional dog trainer and anxiety medications. Medications alone will not fix the problem. I would recommend having your dog assessed by a trainer who works with a veterinarian so the appropriate level of medication and training can be recommended.

(One of my dogs had major anxiety problems when I adopted her. Through the training at Oberlin/Glenwood Animal Hospitals and a mild medication, she is a new dog! Having gone through the experience myself, I understand the frustrations involved with having an anxious dog. But, there is hope!)

Anxiety in dogs can manifest in skin conditions (such as excessive licking and the development of frequent "hot spots" or infections on the feet), destructive behavior when left alone, separation anxiety, social aggression, and even social fear.

Dear Jeanne, "Hot spots" are created by a reaction to the skin's bacteria due to a moist area on the skin. They are very common in the summer months, especially after a rain storm, or swimming.

When the skin gets wet and doesn't dry, the moist, humid air over the skin allows the bacteria to overgrow, creating the skin infection known as a "hot spot." These lesions can also be caused by excessive licking in one area or two.

Is your dog's hot spot always in the same place? If so, it may be caused by anxiety due to being away from home and you may want to talk to your veterinarian about starting your dog on either a short-term anxiety medication while boarding, or a low-level anti-anxiety medication long-term.

The best method for the treatment of "hot spots" are antibiotics and sometimes steroids. Depending on the severity of the lesion, systemic antibiotics are needed and veterinary assistance will be needed. Topical antibiotic and steroid sprays are also helpful for the treatment of these lesions.

Dear Audrey, Science Diet is my favorite food for many reasons. The food is high quality, I have familiarized myself with the company and factory, and the ingredients are a fixed formula (Meaning the ingredients in the food never change unless there is a notice on the bag.

According to the pet food regulations, the ingredients in the food can change without notice on the bag for 6 months, which can cause illness in pets).

Royal Canine is also a good diet. I would avoid the grocery store brands of food, if possible. The quality of the food is not as good (thus the lower price) and many health issues can be traced to a deficiency in the diet. For prolonged health care in your pets, I recommend the higher quality diets over the store-bought brands.

For specific diet questions, talk to your veterinarian for their recommendation for your individual pet's health.

Dear Russell, Weight loss in cats is a very common problem for many cat owners.

Usually, obesity is caused by the amount of food being fed, if the food is a high quality diet. Avoid any of the higher fat food such as Fancy Feast, Deli-Cat, etc. Anything that looks tasty probably isn't good for your cat.

Feeding no more than 1/2 cup total for the day per cat is the next step. Most cats do fine with 1/4 cup feedings twice daily. But, some cats, like yours, can become destructive if they don't have food all the time. Typically, when switching to meals for your cat, feeding 1/8 cup four times a day seems to work well. Feed when you get up in the morning, before you leave for work, when you get home, and before you go to bed. Usually, this is frequent enough that most cats no longer stress about not having food.

If you are already feeding a restricted quantity of food (no heaping scoops!) and your cat continues to maintain his/her weight, then we need to look at a diet change. In the cat world, there are 2 trains of thoughts for cat dieting. One is the high fiber diets, like the Science Diet r/d or w/d, or Iams Restricted Calorie diets. These diets, with the higher fiber, are made to make most cats feel full on the food.

The other thought is a higher protein diet, like the Atkins diet. Talk to your veterinarian before trying this diet to make sure it is safe for your cats. Cats with kidney problems should not be on this diet, since one of the kidney's roles is to clear the proteins from the bloodstream. Science Diet's m/d diet is a high protein, low fat, diet that will help cats lose weight.

Keep in mind, while your cat is on a diet, that the weight loss should be gradual. No more than 1 pound per month.

Finally, if your cat continues to gain weight on the restricted diets, I would recommend talking with your veterinarian to make sure your cat hasn't developed diabetes or hypothyroidism (while uncommon in cats, this is a possibility).

Good luck with your endeavor!

Dear Joan, Benadryl is an antihistamine usually used for allergies or mild allergic responses to insect bites. One of the side effects of Benadryl is sedation. If your dog gets really hyper when going to the groomer, Benadryl may or may not be strong enough. You may want to talk to your veterinarian about prescribing a mild, short-acting sedative, such as Alprazolam if your pet's anxiety is not controlled with Benadryl.

Dear Jan, The cost of an ultrasonic teeth cleaning varies between animal hospitals. I would recommend calling several hospitals to get a price estimate.

How often do dogs and cats need to have their teeth cleaned? Well, that depends on the pet. Some cats are more prone to gum disease and tartar buildup and need to have their teeth cleaned every 1-2 years after the age of 5 or so. Cats with the "smushed faces" such as Persians and Himalayans typically develop tartar faster than other cats and need to have their teeth cleaned more often.

Dogs usually need to have their teeth cleaned every 1-3 years after the age of 5. However, just like cats, some breeds are more susceptible to gum disease and tartar. Greyhounds, Poodles, Chihuahuas, Shelties, and Collies are just a few breeds that come to mind that usually require bi-annual dental cleanings. The length of the jaw and production of saliva are two factors that can influence the tartar buildup in a dog's mouth. Dogs with longer snouts seem to have more tartar buildup than those with shorter noses and require dental cleanings more frequently.

The concern with dental care in your pet is the same as it is in people. Poor dental health can cause gum disease, which in turn can allow bacteria from the mouth into the bloodstream. This bacteria can then attack the heart, kidneys, and other vital organs.

I recommend having your dog/cat's teeth checked at least annually by your veterinarian to determine if a dental cleaning is needed.

Once your pet's teeth have been cleaned, or if you have a young dog or cat with mild tartar buildup, there are some things you can do at home to prevent tartar buildup and space the need for dental cleanings.

CET makes an oral rinse that works really well for dogs/cats that won't let their owner brush their teeth. The CET toothpaste is great! It is an enzymatic toothpaste that breaks down tartar on contact. Daily brushing will decrease tartar buildup. (DO NOT USE HUMAN TOOTHPASTE IN YOUR ANIMALS).

Finally, there are CET chews with the enzyme in it for both cats and dogs that work really well. The more preventative care done at home with your pet, the healthier their mouth will be.

Euthanasia of a pet is a very personal decision an owner has to make. There were several questions on the topic, and I hope to include answers for most of your questions for some clarity.

Many people ask when the appropriate time is to euthanize your pet. How do you know? My recommendation for an owner is to look at their pet's quality of life. Take a sheet of paper. On one side of the paper, write down all the things your pet has always loved to do. Whether it is going for a walk, greeting you at the door, chasing the ball, or hanging out with the family.

Then, on the other side of the paper, write down the things your pet is still able to do. If there is a discrepancy between the two sides, then your pet's quality of life is not as good as it once was. You will know when the appropriate time is to say good-bye to your companion. It is a hard decision for anyone to make, but when it is the right time, the decision will be clear and an owner should not feel pressured into making the decision if they are not ready.

For me, I hate to see pets suffer. As a veterinarian, my job is to fix unhealthy animals, prevent illnesses, and help those who cannot be fixed with euthanization. It isn't cruel and I am very thankful that we have that opportunity to prevent the suffering of our sick and aged friends.

The actual drug is an overdose of an anesthetic. So, the pet goes to sleep, just like going into surgery, only it stops the brain and then the heart. It is not painful, but a peaceful alternative to dying from disease, which can sometimes be painful.

While euthanizing a pet is not my favorite part of my job, since it is so hard to say good-bye to some of my friends, I am thankful for the option to help those animals that can no longer be helped therapeutically.

Owners cannot euthanize their animals themselves. The drug used is a controlled drug and must be administered by a licensed veterinarian. Many people prefer to have their animals euthanized at home and there are many veterinarians who will come to your house for the procedure, so both the owner and the pet are comfortable in their environment. Talk to your veterinary staff if you would like to take advantage of this option for your pet.

If you are concerned that your pet is suffering, I encourage you to speak with your veterinarian for options for your pet, either therapeutic treatment or euthanization options. Cremation services are also available. 

Dear Beth, I am sorry to hear about your Pomeranian. Renal disease is usually something that can be managed, for a time. Long-term prognosis varies, depending on the severity of the disease. Renal disease can be caused by renal dysfunction, severe infection, genetic disorders, an auto-immune reaction to the filter system of the kidneys, toxin insult, and cancer. Whatever the cause, treatment is usually the same, IV fluids to flush the kidneys as well as some medications.

Renal insufficiency is when the kidneys are not working to their full potential and 1 or 2 of the 3 kidney enzymes are elevated in the bloodstream. The BUN (or blood urea nitrogen) is usually the first value to climb. This is a product of protein metabolism by the liver and is usually cleared from the blood by the kidneys and shed in the urine. If the filter system of the kidneys is not working as well, this product will remain in the bloodstream. At increased levels, it can make the pet nauseous or even vomit. The Creatinine is the second level to rise with kidney disease.

This indicates more chronic damage to the kidneys. For both the BUN and the creatinine to be elevated in the blood, 1 whole kidney and 1/2 of the other kidney are not filtering appropriately. If just these two values are elevated, a pet is diagnosed with renal insufficiency. Most of the time, with fluid therapy and a diet change, as well as an antacid, these patients can be managed well long-term.

The phosphorus is the last renal value on the bloodwork to climb. When the kidney filtering system has failed, the phosphorus is no longer filtered into the urine. When all three values are elevated, a pet is diagnosed with renal (or kidney) failure.

My recommendation for renal failure patients is IV fluid therapy for at least 2-3 days, sometimes longer, to see if we can't jump-start those kidneys by flushing them with fluids and clear the bloodstream. Amphogel is a phosphorus binder that is used with patients with renal failure to lower the blood level of phosphorus. There are also medications that can be used to increase the blood flow to the kidneys, allowing the filtering systems that are working to have a greater chance at filtering the blood.

An ultrasound of the kidneys may give an indication to the cause of the renal disease. Whether there is cancer within the kidneys, renal cysts, infection, or chronic damage, the ultrasound will show the changes to the parenchyma that may give a better idea of what is going on and help treat the disease.

When a pet isn't responding to the treatment, even with aggressive treatment, and the blood values remain unchanged, there is not much else that can be done. Kidney transplants have been performed by the surgeons at the NC State Veterinary School with success in cats. Once the kidneys have stopped responding, there isn't much else you can do. I am so sorry.

Several months ago, I lost one of my own dogs to renal failure. He responded to the fluid treatment a few times. But, at the end, he stopped responding and his appetite never came back. It was at that time that I decided to let him go. It was a hard decision, but the best one for him. I didn't want him to suffer anymore.

I wish you the best of luck with your dog. I hope the fluid therapy will work and your dog will respond to the treatment. Long-term management of a pet with kidney failure requires a diet change to something with low protein (like the Science Diet k/d diet), antacids, amphogel, and fluids given at home under the skin.

Dear Sharon, Hip dysplasia is unfortunately a fairly common disorder that affects many breeds. It is caused by an unequal hip joint, where either the cup in the pelvis (called the acetabulum) isn't round, smooth, or deep enough, or the ball of the femur isn't round enough and as the ball of the femur moves in the cup of the pelvis, it rubs and creates pain and inflammation. Over time, arthritis forms in the joint and is very painful with each step.

Ideally, hip replacement surgery or FHO (femoral head osteotomy) are recommended to reduce the pain in the joint.

For those patients where surgery isn't an option, there are a few things I typically recommend. The first is Cosequin, it is a glucosamine chondroitin supplement. This is a nutriceutical that builds up the fluid in joints. This fluid helps to lubricate the joint and reduces the contact between the bones. There are other forms of this supplement. Cosequin is my favorite, however.

The second thing I recommend is an anti-inflammatory, such as the Carprofen (Rimadyl). Usually, after 10 days of the medication and no activity, the body will reduce the inflammation around the joint. Then, it can be given as needed. (For example, if you were going to go for a walk on Saturday, you would give the medication on Friday, Saturday, and Sunday.) Some dogs need the medication all the time, which is fine, too.

Sometimes, if a dog has been on a particular medication for a few years, it will lose its efficacy and the medication will need to switched. Some of the other anti-inflammatories are Metacam, Zubrin, Deramaxx, and Etodolac. Any dog on any of these anti-inflammatories needs to have bloodwork checked every year to make sure the liver and kidneys are not being affected by metabolizing the medication.

Talk to your veterinarian for any medication questions concerning your dog. As he gets older, there are other medications that can be added to the anti-inflammatory to help control the pain.

The third recommendation is a food called Science Diet j/d. This is a joint diet, specially formulated to lubricate the joints. I have seen many dogs improve tremendously on this food and would recommend it for your dog as well.

Fourthly, fish oil capsules. The fish oil is another joint lubricant. 1000 mg capsules can be purchased from Walmart. For a 65 pound dogs, they would get 2 capsules a day.

Finally, I would recommend some sort of physical therapy to build up the muscles around the joint, so the joint isn't just a boney joint, rather the muscles are taking the weight of the joint instead. Swimming is a great way to build muscle without putting any weight on the legs. Dancing will also build up hip muscles as well. There are several rehabilitation clinics for dogs in Raleigh that work with dogs with similar conditions as well: VetHab and Animal Wellness and Rehab.

Hope that gives you some ideas!

Dear Greg, I am sorry to hear that Hunter has been diagnosed with lymphoma. Have you talked with your veterinarian about some options? I typically recommend chemotherapy for my patients diagnosed with lymphoma.

Fortunately, it is one of the cancers that does respond to the chemotherapeutic agents. If there isn't any response to the chemotherapy, then there isn't anything else you can do, other than keep him comfortable on steroids.

Depending on where the lymphoma is (in the lymph nodes, spleen, blood stream, etc.) the clinical signs vary. Some dogs show signs of gastrointestinal upset, others are severely lethargic and anorexic.

You will know when it is time to let Hunter go. He will let you know.

I recommend talking to your veterinarian or a veterinary oncologist to determine if Hunter's lymphoma can be put into remission with chemotherapy. If anything, you may get to have a little more time with him if we can slow the progression of the disease with the chemotherapy.

(Chemotherapy in dogs does not have the severe side effects people experience and very rarely do they lose any hair, if anything their whiskers will fall out and any shaved spots typically don't grow back as fast. Some dogs have mild GI upset. But, that's it)

I wish you and your family the best of luck with Hunter.

Dear Tony, Reverse sneezing is very common is small dogs. It looks like an asthma attack, where they will stand still and look like they are struggling to inhale air through the nose. It is basically a sneeze, inside out.

Usually what happens is that they get something caught in their nose (a grass piece, dirt, or even mucus-very common during pollen season). Then, instead of blowing out, they try to suck it in!

The best way to help stop the spasm is to put some water on the nose, so as they suck in, it will cause whatever is in there to clear. You can also squeeze lightly on the "Adam's apple" or larynx in the throat for about 10 seconds and that should stop the spasm.

This is not anything to be concerned about. If your dog is having frequent episodes, there may be an increased mucus buildup in the nose, and your dog may need a course of antibiotics. Talk to your veterinarian if the attacks become more frequent.

Dear Pat, If your dog gets bitten by a snake, you need to take your dog to an emergency clinic right away.

I am not familiar with the Sanford area in terms of veterinary practices, but there are several emergency clinics in Raleigh: N.C. State Veterinary School, VSH in Cary, and Afterhours Emergency Clinic.

Some general practitioners will also see emergencies at their clinic. Talk to your veterinarian for their recommendation of what to do afterhours. But, a snake bite is an emergency and needs to be treated as soon as possible for the best outcome.

Hopefully your dog won't get bit!

Dear Betty, I typically will tailor my vaccine recommendations for each pet. Typically, older cats have longer titers for vaccines and can get their vaccines every 3 years rather than every year. But, it depends on the cat and the age of the cat.

The N.C. law requires a rabies vaccine or titer every 3 years. If you choose not to vaccinate your cat every year, an annual exam and routine bloodwork is recommended.

While vaccines are one reason owners bring their pets to the veterinarian every year, your veterinarian is also checking the health of your pet and screening for any potential illnesses that may be developing as they age. I prefer to see older cats 1-2 times a year for a routine exam and bloodwork. Cats age 7 years for each of our human calendar years.

I would recommend talking with your veterinarian about his/her recommendations for your cat, and plan to continue to have routine physical exams performed.

Dear Nina, The debate of whether to feed once or twice daily is a very common debate. Just like people, smaller meals more frequently will help keep a pet's metabolism a little higher than if fed one large meal a day.

One disadvantage of feeding one large meal, especially in the larger, deep-chested dogs, is that it can predispose them to bloating. I recommend feeding a morning meal and an evening meal.

The amount you feed your dog can also affect their weight. Some dogs are more active than others and require more food, but in general, I recommend the following feeding guidelines:

(This is TOTAL food for the day, but split up in 2 feedings)

Dear Cindy, if your daughter's passion is to become a veterinarian, then tell her to follow her heart and it will lead her into the most wonderful profession.

Although many people believe becoming a veterinarian requires strong science skills, while it does, there are other strengths that can lead a student into veterinary school and throughout the years while in school.

Several of the students in my veterinary school class were English majors, for instance. Others were teachers. One had a PhD in plant physiology. As long as your daughter takes the required classes in undergraduate school for entrance into veterinary school, she will do fine.

There is always people to help on the way (tutors, TAs, teachers, other students). Your daughter is not quite into the high school levels of the sciences, and she may find that she excels in those classes (that was when it really got interesting for me!).

My greatest advice for your daughter is to get involved in whatever she can to help science become alive for her. Clubs in school, extracurricular activities, volunteering at any of the museums as she gets older, 4H activities, or working with rehabilitation animals with the rescue organizations are all ways to learn more about how science is really used in everyday life. This may help.

As a student, math was always a strong point for me, and something I enjoyed, but I learned to love the sciences when I got into high school and traveled through Biology, Chemistry, and Physics.

Your daughter will be a veterinarian if she puts her heart into it. Continue to support her over the next few years!