All About Fleas – Part 1 of 2

Ahhh, summer!  What’s better than a Western Washington summer, with our warm days and still enough moisture to keep our beautiful, lush greenery?  We all love it, and so do our pets, but unfortunately, we have some unwelcome guests that love it too… Fleas!

Cat_FleaFleas thrive in warm, moist weather.  Since we have such a perfect environment for fleas, it’s hard to completely avoid them, but in this two-part series, for our July and August blog posts, we’ll give you a little background information to aid in recognition, prevention and treatment:

If you are lucky enough to have never had a pet with fleas before, let’s start with a description of what to look for…

Identifying a Flea Problem

Flea combFleas are a brown to reddish-brown parasite that can easily be seen without magnification.  Since they are about 3 mm long, you would think the diagnosis should be easy, but frequently, finding fleas is not as simple as it sounds.

We all know that scratching can be a sign of fleas, but what else should we be looking for?  One of our most common ways of diagnosing fleas is to do a flea combing. We use a very fine tooth comb, especially designed to trap “flea dirt” and sometimes even adult fleas.  The most likely place to find “flea dirt” or fleas is the dorsolumbar area: on top of the back of the dog or cat, near their rump, basically from the mid-back to the tail.

flea dirtThe term “flea dirt” is a euphemism for flea feces. It is a dark reddish-brown to black material that looks like specks of dirt, but can often be seen to have a long, slightly curved shape, like a comma.

To distinguish flea dirt from garden dirt, just place it on a white tissue with a drop of water and gently rub it.  If a faint rust color appears on the tissue, you’ll know it is the digested blood of flea dirt.

Sometimes we don’t have the luxury of seeing fleas or “flea dirt.”  Other signs of fleas may include:

  • Dorsolumbar alopecia (hair loss on the rump)
  • Scratching or biting at the skin with the front teeth
  • Red or crusting skin
  • Greasy fur
  • “Hot spots”
  • Twitching or chewing when being pet or scratched

Because our feline friends are such fastidious groomers, they can make it even tougher to find fleas. Sometimes we don’t have obvious signs of fleas, but need to rule it out.  If your pet has signs of skin disease or pruritis (itching), but we don’t find any fleas or “flea dirt,” you may still be asked to do a trial of flea control to see if it alleviates signs.

Given that fleas are so ubiquitous in our area and fairly easy to treat, compared to some of the other skin issues, a flea control trial is usually wise.

Sometimes we see clients that are concerned that we will think they don’t take good care of their pet because they have fleas. Obviously, since you brought your pet in for a visit, you’re a conscientious pet owner!

Never feel bad that your dog or cat has fleas.  We’re here to help you fix it. 

flea dermatitis

Secondary Problems Due to Fleas

Sometimes a dog or cat can have fleas for just a short time, but develop dramatic skin lesions due to a hypersensitivity called flea allergy dermatitis. This is an allergy to the flea saliva that is injected into the skin at the time of the bite. Animals with this type of hypersensitivity can induce enough self-trauma by scratching, biting and chewing that hair loss and red, bleeding skin can develop in a matter of weeks.

Besides an annoying itch and skin allergies, the stress of chronically itching can also play a role in your pet’s mental well-being.

Another very common problem secondary to fleas, is tapeworms. Dogs and cats will naturally groom fleas off of themselves and become infected with tapeworms from ingesting the fleas.

How can you identify tapeworms? The photo at right shows sesame seeds on the left, tapeworm eggs on the right. You may see these rice-sized, pale yellow or white tapeworm segments at your pet’s back end or in fresh stool, They may also be seen on the fecal intestinal parasite screen.

A less common secondary problem is anemia. Anemia can either be due to blood loss from heavy or chronic flea infestations, or from a bacteria that is spread by fleas, which attacks the red blood cells.

Also, although rare, the bacteria (Yersinea pestis) that caused the Bubonic Plague is still transmitted by fleas!

Winter Weather Doesn’t Always Kill Fleas

Surprisingly, one of our trickiest times of years for fleas is winter. As the warm weather wanes, we tend to let down our guard. Fleas, however, are hardy little buggers and they can survive some fairly extreme conditions.

In fact, adult fleas aren’t killed by temperature fluctuations unless held below 20°F for 48 hours or in 120°F of dry heat for several days! 

Plus, many of our pets get fleas from other animals rather than from our outdoor surroundings, resulting in a “flea reservoir” even when the fleas cannot survive outdoors.  For these reasons, we should consider our flea “season” as year-round.

Now that you know what to look for, and a little about some of the secondary conditions associated with fleas, you’ve just about graduated from Fleas 101!  Stay tuned for more in our August blog post, where we will prepare you for battle by discussing treatment.

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That Doggone Itch!

By Naomi Keiper DVM

One of the more common reasons for dogs to visit the veterinarian is itchy skin. Pruritus (itch) can be a frustrating condition for both owners and veterinarians due its many complex underlying causes and the challenges in achieving adequate control in some dogs.

Dog scratching lgEvery patient presenting for itch is unique and there is not one correct solution that will work for every dog. It may take time to find a treatment combination that best addresses your dog’s specific issues.

When presented with an itchy dog a veterinarian will take a systematic approach to diagnosing the disease. Two of the most important steps in this approach are obtaining a detailed history from an owner and performing a thorough, full-body physical exam.

Next steps may include skin scraping and cytology (examination of cells under a microscope) to look for external parasites, the presence of bacteria and the presence of fungal organisms. At the same time fecal testing, blood work and urinalysis may be recommended on a case-by-case basis.

fleas-on-cat-furIf no infectious organisms are apparent from the above testing your veterinarian may still treat for fleas, even if they were not directly observed. Fleas can be a major trigger for itch in dogs and their removal/prevention will facilitate a more comfortable dog. Many dogs with strong reactions to fleas have a condition called flea allergy dermatitis (FAD). In dogs with this condition the animal is allergic to the saliva of the flea, which elicits a full-body immune response that can last for weeks after an initial bite, causing long lasting itch.

If a secondary bacterial or fungal skin infection is present, your veterinarian will treat for this before instituting other treatments. Secondary infections often arise due to a poorly functioning or abnormal skin barrier. A dog’s skin provides a wall to the outside world, defending internal systems from a variety of insults including bacteria, fungal organisms, external parasites, pollen, chemicals and other irritants. Dogs with itchy skin often have an underlying disruption to their skin barrier, which makes them more susceptible to secondary infections. Treatment with an oral and/or topical antibiotic until infection has cleared will be used as necessary.

shutterstock_109136528 smallOnce external parasites and secondary bacterial or fungal infections are controlled, one of the next steps in diagnosing the itchy dog is a diet trial to assess for food allergy. Strict diet trials can identify components of food that should be avoided for an individual dog.

The majority of dogs are allergic to the protein source (ex. chicken or beef) rather than the grains within a food. Diet trials can be accomplished by feeding a novel protein diet (ex. Kangaroo or bison) or by feeding a prescription hypoallergenic diet. Diet trials can be challenging because even a single bite of what the dog may be allergic to, either in a treat or dropped morsel of food, will necessitate starting the trial from the beginning.

If a dog remains itchy despite trying the therapies/approaches listed above then a diagnosis of atopic dermatitis may be made. Atopic dermatitis is a chronic hypersensitivity condition that causes itchy inflammation of the skin and ears. Atopic dermatitis cannot be cured however it can often be controlled for the life of the patient.

Atopic Dermatitis

Animals with atopic dermatitis have an abnormal skin barrier (leading to sensitive skin and a higher likelihood of developing secondary infections) and an overactive immune system that will overreact to certain triggers. Triggers may include: dry skin, food allergy, fleas, infection and environmental allergens. Allergen specific immunotherapy is currently the only available method for improving a dog’s immune health. This therapy involves exposing an animal to very small quantities of environmental allergens to which the individual is specifically sensitive (ex. dust mites or birch pollen) though the use of subcutaneous injections or sublingual drops.

When further treatment is deemed necessary to address atopic dermatitis, a multi-modal approach is often used that may include the use of antibiotic/antifungal shampoo, grooming, antihistamines, omega 3/6 fatty acids and immune modulatory drugs.

Immune-suppressive drugs like steroids are often the least expensive option but should be avoided if possible due to their unpleasant side effects and potential harm to organs with long-term use. However, other immune-modulatory drugs may be great options for your pet. These drugs, in contrast to steroids, more specifically target parts of the immune system directly involved in itch and thus have fewer side effects.

In conclusion, itch in dogs can be simple to treat but can also be a sign of a complicated disease that will require extensive long-term treatment. Every itchy dog is assessed as an individual to create a patient specific treatment plan. It is important to remember that working closely with a veterinarian over months or years and being open to treatment changes will be the best approach to making an itchy dog as comfortable as possible.

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Nutritional Options for Anxiety and Stress in Dogs and Cats

Anxiety and stress related problems are unfortunately quite common in dogs and cats. Thankfully, Bothell Pet Hospital has some solutions that might help you and your pet cope with this problem more effectively.

Stressed dog dalmatianSome of the common causes of stress may include:

  • Insufficient socialization
  • Inadequate training or care
  • Loud noises such as fireworks or thunderstorms
  • Kenneling and travel
  • Conflict between pets
  • New owners or a new environment

Stress affects pets directly, through the behavior problems it creates, and also indirectly, through the physical conditions it can create or worsen.

Signs of stress may include:

  • Excessive vocalization and panting
  • Hiding and running away
  • Destruction of property and self (e.g. excessive licking)
  • Inappropriate elimination
  • Aggression toward people or other pets

Fearful dogNew Nutritional Supplements for Stress

Fortunately, Bothell Pet Hospital now carries some new nutritional supplements as options for managing stress in our beloved canine and feline companions. These include Solliquin™, a combination product from Nutramax™ labs that is available in a chewable supplement for dogs and cats, or Zylkene™, containing alpha­casozepine, a milk protein extract from Vetoquinol™, that comes in a capsule form that may be given orally, or sprinkled over food.

These are intended either for situational use or for longer term.

These supplements contain natural ingredients that can be found either alone or in combination. They help to provide relaxation without sedation or the side effects of prescription medications, but may also be used in conjunction with prescriptions for more severe cases. They may also help pets be more receptive to behavior modification training.

While these supplements are not intended to replace professional help, they can definitely help to take the edge off.

Please give us a call and talk to your veterinarian if you think that your pet may be suffering from stress or anxiety.

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A Case of Xylitol Poisoning in a Dog

Did You Know Xylitol Can Have Serious and Fatal Effects in Dogs?

Xylitol types
by Dr. Lesley Kovar

Kaiya is a 2 year old Husky who, a couple of weeks ago, ate protein bars baked by her owner. Several hours later, she started vomiting and having diarrhea. Many of us have naughty pets that get into things they should not, and typically the worst we see as a result is some digestive upset. In this case, however, the protein bars were made using xylitol as a sugar substitute. Xylitol is a very toxic substance for dogs.

Kaiya 2When the owner called Bothell Pet Hospital the next day, we advised taking Kaiya to an emergency hospital, suspecting that intensive care would be required. Upon admission, her blood results indicated severely elevated liver values. One enzyme, which leaks into the bloodstream from damaged liver cells was 240 times normal! Also, her blood clotting times were markedly prolonged (the liver produces blood clotting factors- and if liver function is compromised, production of these proteins can be decreased).

Kaiya spent 5 days at the specialty center, being treated with intravenous fluids and liver protectants, and she received plasma transfusions to replace clotting factors as well. Happily, she was discharged once she was eating on her own and feeling stronger. A recheck of her blood work 10 days later showed amazing improvement! The liver is a body organ that is able to heal itself once the insult is removed if there has not been irreversible damage.

Fortunately Kaiya survived this toxicity, even though her prognosis was very guarded. She is unlikely to have any long term effects. But the ending is not always so happy. It takes very little xylitol to cause clinical signs in dogs.

Two effects of ingestion are hypoglycemia (low blood sugar) and liver injury. There are established toxic doses that we use to determine what treatment, if any, is indicated. Per calculations, 1-1/2 sticks of xylitol-containing gum can cause hypoglycemia in a 10 pound dog. In order to cause liver damage, that same dog would need to eat a full package of the gum.

Kaiya 3Xylitol is a sugar alcohol that is being used increasingly as a sugar substitute in many products. We now see it as an ingredient in gums, candy, baked goods, and peanut butter (yes, peanut butter—so be careful for those of you who use it as a treat or as means to administer medication). In humans, it has cavity-prevention properties, so it is now found in oral hygiene products as well.

While consumption is considered safe for people, dogs can develop serious, if not fatal, effects from ingestion.

So far, ASPCA Animal Poison Control has not received reports of Xylitol issues in cats.

There are now several products on the market containing xylitol for dental care in the pet industry. The product is added to the drinking water for its antibacterial action. The content of the xylitol, if used according to directions, is low enough to not have any adverse effects. Care must be taken to dose for the smallest pet in the home if multiple pets share a water bowl.

The ASPCA Animal Poison Control receives thousands of reports of xylitol cases every year, and the numbers are increasing as more products containing the sugar substitute are becoming available. Be very careful if you have any in your home!

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Lily Plants and Cats are a Toxic Combination

Anika and SplashOn one of our recent sunny days, Dr. Smith and her family were doing yard work when their kitty Splash decided to munch on the leaves of some daylily shoots that were coming up. Lily plants are highly toxic to cats: Easter lilies, daylilies, tiger lilies and other members of the Liliaceae family can cause kidney failure and death.

Photo: Dr. Smith’s daughter Anika and their kitty, Splash.

Luckily for Splash, her humans were right there, so she did not ingest any lily shoots and is doing just fine. But this was a great reminder for us all to be aware of what plants we have in our yard and in our homes that may be toxic to our pets.

Lillies and Cats

All parts of the plant, including the petals, stamen, leaves, pollen or the water in the vase of cut lilies are toxic.

Even if as little as one leaf is consumed, it can produce severe toxicosis.

Early signs of lily intoxication include drooling, vomiting, lack of appetite and depression.

If you think that there is even a slight chance that your cat has eaten or chewed part of a lily plant, time is of the essence! Contact your veterinarian or nearest emergency clinic immediately with your suspicions. Early treatment can save your cat’s life.

Lilies and Dogs

While the majority of lily plants are not toxic to dogs, lily of the valley and peace lilies are deemed dangerous to dogs by the ASPCA.

Other Potential Hazards

Other Potential hazards in the yard could also come from fertilizers, insecticides, sharp garden tools and cocoa mulch, which has become increasingly popular. Slug and snail bait and rat poisons are especially dangerous.

If you believe your pet has possibly ingested any poisons or toxins it is important to call your veterinarian immediately. Do not wait to see if your pet is okay after a period of time. If at all possible have the packaging of the product available for your vet. If it is after hours, then contact a veterinary emergency clinic or call the ASPCA at

To view a list of toxic and non-toxic plants, visit the ASPCA Animal Poison Control Center’s website HERE.

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Updated Spay and Neuter Recommendations

Not just rabbitsBy Dr. Kim Hsu, Bothell Pet Hospital

It has been said that practicing medicine is an art. Doctors continuously make recommendations that affect the health and well-being of their patients both short and long-term. The latest technology, new research findings, and owners’ resources all factor in to our diagnostic and treatment plans. These can be constantly changing.

For example, we recently reevaluated our recommendations on when to spay or neuter your pet. While the debate on whether or not to spay/neuter remains unchanged at this time, recent studies have created controversy within the industry over the best time to spay or neuter, specifically dogs.

The Right Age to Spay / Neuter

Chances are that if you adopted your pet from a shelter or rescue group, your pet was already spayed or neutered. These organizations are up against the challenge of over-pet population and providing the healthiest animals for potential adoption. It makes sense to spay or neuter these animals beforehand, even if done at an earlier than typical age.

Dr-Hsu-surgery-webVeterinarians have historically recommended spaying dogs at about 6 months of age, before the first heat cycle, but when they are bigger to tolerate anesthesia better.

Studies show that estrous (heat) cycles increase the risk of mammary cancer in dogs. If spayed before the first heat, there is almost a zero percent chance of mammary cancer.

After the first heat, various studies estimate the risk goes up to 12-16% (some studies say up to about 25%). After the second heat cycle, spaying seems to have minimal, if any, impact on preventing mammary tumors.

New Studies Suggest a Benefit to Delayed Spay / Neuter

Recently, there have been a number of studies suggesting a benefit to waiting to spay or neuter. Estrogen could have a protective effect against certain cancers and oxidative stress. Dogs spayed later lived longer. Another study correlated later spay and neuter with lower incidences of certain types of cancers and joint disorders.

It is important to note that these studies were done in larger breed dogs, for example, Golden Retrievers, Labrador Retrievers, German Shepherds, and Rottweilers.

So what about mammary cancer? Well, it turns out that mammary cancer in intact females in larger breeds is relatively low. There are huge breed differences, and more studies need to be done.

cat spay neuter graphic

Bothell Pet Hospitals’ Recommendation

As mentioned before, there is still controversy and conflicting information on when to spay or neuter your dog. However, the doctors at Bothell Pet Hospital have concluded that there is enough evidence to support later spay/neuter in larger and giant breed dogs to minimize the risk of joint disease and certain cancers.

We are still recommending spay/neuter in smaller breeds at about 6 months of age, before the first heat cycle, to avoid mammary cancer.

In addition, cats should also be spayed or neutered at about 6 months of age.

There are clearly breed differences, specific individual circumstances, and other factors that influence the decision on when to spay/neuter. The point is, talk to your doctor about what is best for you and your four-legged family member. Like you, we want the longest, healthiest life possible for them.

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Ear Infections (Otitis Externa) in a Dog or Cat

dog shaking head cropImage by German photographer Elke Vogelsang

It’s time for a pop quiz! What is the number one reason for vet visits? If you said ear infections, you’re right!

According to Veterinary Pet Insurance, this was the number one reason for canine vet visits in 2015. It also made the top 10 for cats, at number seven. With just a little background knowledge on ear infections, you may be able to recognize this problem sooner and clear it up more quickly in your pets.

dog ear canal

The ear canals in cats, and especially in dogs, are much longer than humans. It begins with a vertical ear canal, which makes a turn to become a horizontal ear canal, before reaching the tympanic membrane, or ear drum. Most ear infections are in these canals, on the outside of the ear drum. We call this otitis externa.

Identifying Otitis Externa (Ear Infection) in a Dog or Cat

Dog ear crustThe most commonly noticed signs are scratching the ears and shaking the head. However, some dogs and cats don’t give such clear clues. You may have to check the ears for discharge.

It’s normal to have a tiny amount of waxy or dirty debris caught in the folds of the ears, but if you see larger amounts of red-brown or creamy yellow discharge at the opening of the ear, this could be otitis.Cat ear infection sq Often times the discharge is malodorous and the skin of the affected ear(s) will be red.

Other signs that people sometimes notice are groaning and leaning into your hand more when scratching one ear over the other, discomfort, or the sound of liquid deep in the canals when you rub the ear.

Treating Ear Infections in a Dog or Cat

When you bring your pet in to see us, we will use an otoscope, with light and magnification, to examine the canals and tympanic membrane. By doing this, we will be able to make sure there is no foreign body present, such as plant material, and we will be able to check the health of the tympanic membrane.

If we suspect an infection, we will swab the discharge lining the canal and roll it onto a microscope slide. A microscopic exam of the discharge enables us to rule out ear mites, a less common cause of infection in house pets. Staining the slide will highlight any yeast and/or bacteria on the rest of the microscopic exam.

It is important to know what organisms are present in order to choose the best treatment and to monitor the resolution of the infection.

Vet treating ear infection

The Reasons for Repeated Ear Infections

Dogs and cats that get repeated infections often have an underlying condition predisposing them. Some dogs are simply born with very narrow ear canals (shar peis), long droopy ear flaps that cover the canals (retrievers and spaniels), or excessive hair in the canals (poodles), all of which trap moisture in the ears, setting up a perfect environment for the skin’s normal yeast or bacterial inhabitants to flourish and overgrow.

Endocrine diseases such as hypothyroidism and Cushing’s disease can be predisposing factors, too. These diseases are sometimes also accompanied by hair loss and other skin infections.

Younger cats may have a polyp, or tissue growth that predisposes them to infection. A less common cause in middle-aged to older pets can be tumors.

However, most commonly we see allergies as an underlying cause of otitis externa. These allergies may either be environmental allergies, called atopy, or food allergies.

Getting to the bottom of an ear infection can be tricky sometimes. A little knowledge about how to identify an ear infection and what causes them may help you get some relief for your furry friend sooner!

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