Monthly Archives December 2017


Hairball Vomiting: A sign of illness or just a fact of life for a cat?

By Erika Ball, DVM


There are many services that we perform for our feline overlords. We wait on them hand and
foot, maintain their bathroom areas to the highest standards, giving massages on demand at
regular intervals, allowing them to steal our warmth on cold nights….I could go on and on. One
of these duties that we find ourselves performing is cleaning up the occasional hairball.

Some degree of hairball vomiting is normal, even expected. However, your definition of what
constitutes a hairball may differ from mine. Just because there is hair in what your cat vomits
does not make it a hairball. Cats groom. When they do, they ingest hair. When they vomit for
any reason there is a good chance that the vomit will contain hair. When I refer to a hairball, I
am specifically referring to a tubular structure that consists of mostly hair, wadded and woven
together. From a distance it often resembles stool. This is much more common in long haired
cats, whose fur is finer and longer and much more likely to form a conglomerate that can
bounce around in the stomach, getting larger as more hair is added to it. That is not to say that
short haired cats don’t get hairballs, only that it is less common.

Most of the time hairballs are harmless. Usually you don’t know that there is any problem until
one comes up, usually on your bed or your expensive new carpeting. Occasionally, hairballs
can cause problems, even serious ones. If a large enough hairball should manage to pass into
the intestines it could cause an intestinal obstruction. It is the most common “foreign body”
obstruction I find in adult cats upon surgical exploration. On one occasion I found a giant
hairball that took up 1/3 the volume of the stomach. The cat’s only symptom was drooling. He
was still eating, and there was no vomiting. There are over-the- counter hairball “remedies” and
even diets or treats that claim a reduction in the number hairballs your cat might have. While
these products may help (I’m not convinced these are all that effective) by lubricating and
making it easier for the hair to pass into the intestines, you still run the risk of an obstruction
occurring. There is one really good way of minimizing or even eliminating hairballs, but you
might not like it. Have a groomer give your long haired cat a lion cut twice a year or so. This
will significantly cut down the hair ingested and your cat will feel GREAT! They don’t like having
all that hair to contend with either. You may even like the way it looks!

So what if the vomit is food, or liquid, even if there is a little bit of hair? This is true vomiting, not
hairball vomit. The one exception to this is that your cat is vomiting as a result of an obstructive
hairball. Either way your cat should be seen by a veterinarian. Vomiting can be caused by a
variety of illnesses, such as food intolerance or allergy, inflammatory bowel disease,
pancreatitis, a non-hairball obstruction, metabolic diseases such as hyperthyroidism or kidney
disease, parasitic infection, toxin ingestion, etc. Cats RARELY vomit because they “eat too

Your veterinarian needs to perform an exam and diagnostics to determine the cause of the
vomiting and implement the best treatment for your cat. There was a time in my career that I
accepted a certain amount of vomiting as “normal” for a cat. I now know that the single most
common cause of chronic vomiting is intestinal disease, and should not be ignored. There are
diagnostic tests that needed to narrow down the cause of the vomiting, including blood work, x-
rays, and abdominal ultrasound. Ultimately an exploratory surgery with intestinal biopsies may
be necessary to diagnose the cause of your cat’s chronic vomiting.

When is it time to consult with a veterinarian? When your cat is vomiting regularly (more than 2
times per month), severely (multiple episodes in a short period of time) with or without hairballs,
when there is a decrease in appetite, becomes lethargic, has blood in the vomitus, is losing
weight, has concurrent diarrhea, and/or is either worsening or not improving rapidly. Don’t
dismiss vomiting as a normal part of being a cat. It’s not, and your cat’s life may depend on
being seen and worked up properly by a skilled veterinarian.

Feline Dentistry-What a Pain! Part 1

Dentistry – What a Pain! Part 1

By Erika Ball, DVM

If I were to ask you what you thought was the most common surgical procedure that I perform at my hospital, what would you guess?  I’ve already given away the answer, but without that hint you likely would have guessed spays and neuters, am I right?  The fact is, the number of dentistries I do far exceeds the number of spays, neuters, and all other procedures that I do combined!  Pretty much all pets would benefit from dentistry at some point(s) in their lives. I am specifically a cat vet, but most of the principles I am about to discuss apply to both dogs and cats.

How much training in dentistry do you think veterinarians get in veterinary school?  Quite a bit, right?  That would be a logical answer, considering we do more dentistry than any other procedure.  I hope you didn’t bet any money on your answer, because you would lose.  The answer is, with few exceptions, little to no training at all in dentistry.  I think I watched a dental cleaning once in vet school.  We spent more time on diagnosing oral tumors than routine dental cleanings and extractions.  Now Imagine you have a toothache.  Do you go to your primary care physician?  Would you let them extract it or would you rather be sent to a dentist or oral surgeon for that?  The human dentistry field originally developed as an off-shoot of general medicine as it required a considerable amount of training above and beyond what is taught in medical school.  The same applies to veterinary medicine.  If you are a graduate of veterinary school, and want to perform dentistry properly, you must seek additional training.  There are boarded veterinary dentists, for sure, but they are few and far between, and may not be an feasible option financially or locally for many pet owners.  It is up to veterinarians to seek that additional dental training post graduation in order to do right by our patients. Everything from recognition of various dental lesions and diseases, taking and interpreting dental x-rays, performing nerve blocks, to proper treatment and oral surgery techniques needs to be learned, as none of this is even discussed in most veterinary schools let alone practiced. Unfortunately the majority of vets never seek out that training, and more concerning is that they may not even realize that they need it.

Let’s talk a little about anesthesia first.  In order to properly clean a pet’s teeth, measure periodontal pockets, clean out bits of tartar that have extended underneath the gingiva, take x-rays, and ultimately perform extractions, the pet MUST be under general anesthesia.  This is for the safety of both your pet and the personnel performing the cleaning, as well as for the thoroughness of the procedure.  Don’t be fooled when your groomer tells you that they’ve cleaned your pets teeth.  They may look nicer externally, but ultimately hasn’t doesn’t your pet any good.  They are most certainly not cleaning up under the gumline, nor are they cleaning the inside surfaces of the teeth.  In addition, sometimes removing that tartar exposes painful and diseased teeth which can cause further pain.  Sharp instruments are frequently used to clean teeth, and if your pet moves during this process it can result in a laceration of the gums or worse.  Many people are afraid to put their pets under anesthesia, which is understandable.  Anesthesia is not without risk, and should always be taken seriously.  Prior to anesthesia your pet should have a thorough exam, have a blood work panel performed to screen for diseases that may increase the risk of anesthesia.  I also routinely recommend running a relatively new test that can screen for hidden heart disease, which can be a big problem in cats and can significantly impact your cat’s risk for anesthesia.  In some cases an ultrasound of the heart should also be considered prior to anesthesia.  Anesthesia, when performed properly, especially with the appropriate pre screening tests, is actually quite safe.  In order to induce and maintain anesthesia safely each pet should have an IV catheter through which fluids, and emergency drugs (if needed) can be administered.  The administration of intravenous fluids during anesthesia is essential for maintaining a normal blood pressure to protect your cat’s vital organs.  They should have a preanesthetic mixture consisting of small amounts of several different sedating medications, as opposed to a large amount of a single drug.  Pain medication should always be included in this combination, as preventing pain is much more effective than trying to address that pain once it arises.  Next an inducing agent is given.  Once anesthesia is induced with this fast acting and rapidly eliminated agent, a breathing tube should be placed and your cat is maintained on gas anesthesia.  This breathing tube also allows administration of oxygen and prevents the debris, fluid and bacteria from the mouth from entering the airways.  There should be a dedicated and properly trained technician present to monitor the anesthesia at all times.  Monitoring equipment should include multiple factors and parameters, including ECG readings, temperature, oxygen saturation of blood, blood pressure, heart and respiratory rate, etc.  This should not be the same individual that is cleaning the teeth and taking x-rays.  You cannot effectively monitor anesthesia while simultaneously performing these other tasks.  Anesthetic emergencies and death rarely occur without some advanced warning, but you need to be actually monitoring the anesthesia in order to pick up on these warnings.  There is so much more about dentistry that I want to discuss with you, so this article will be a two-parter.  Stay tuned for part 2.


Cats are Sneaky!

Cats are Sneaky!
By Erika Ball, DVM

     Cats are truly amazing creatures. They are for the most part loners in the wild, the one
exception being lions, yet have the greatest capacity to love. They are our furry babies, and
members of our families. They never grow up and move away as our human children will all
eventually do. Our attraction to these wonderful animals goes far beyond how adorably cute
and loving they are. They can also be incredibly naughty and aloof at times and somehow that
endears them even more to us. They each have different personalities and if you haven’t
already discovered this, it is ultimately the cat that sets the rules in the household. You can try
to discipline them all you want, but when it comes down to it, they still do what they want. As
soon as you aren’t looking they are on top of those tables and counters that you worked so hard
to keep them off. So why do we cater to these creatures, putting their wants and needs before
our own, and why, no matter how naughty they are, do we forgive them every single time?
Whatever the answer may be, cats are here to stay in our lives.

     Cats are graceful and stealthy. They adapt to most environments. They are also incredibly
effective hunters. Cats “moved in” with humans around the same time that man began storing
grains and needed a way to keep the mouse population down and out of the foods being stored.
In exchange for cats’ hunting services they were provided with shelter and food scraps. Unlike
cats’ much larger cousins (cougars, leopards, jaguars, tigers , cheetahs, lions, etc.), they are
also small enough to be prey for larger predators, such as coyotes, and cougars, bears, even
large birds of prey.

     It is as a direct result of this predator-become- prey phenomenon that many cats have a
“scaredy cat” personality. In the wild that instinct might just save their lives. Whether this fear is
of a vacuum cleaner, or a new dog in the household, or loud noises, many cats will run or fight
“for their lives” instinctually. When one is in the “wild”, showing signs of weakness can result in
targeting by a larger predator species.

     What does this mean for cat owners? The most common consequence of this instinct is that
cats may suffer from pain or illness for an extended period of time (even years) without the
owner recognizing that there is a problem. Cats are masters of hiding even very high levels of
pain. Unfortunately this means that we often don’t see cats until their illness is quite advanced
before they are brought in for care. The impression by many of these owners is often that the
cat may have only been sick for a few days, when in actuality the disease may have been going
on for a significantly longer period of time. A common example is a cat that is brought in for
“not eating or drinking for several days”, but was drinking “very well” up until recently. When we
do blood work on this cat we may find that it is in an advanced stage of kidney disease. This
doesn’t occur over a matter of days. It more likely occurs over months to even years. There are
things that might have been done prior to this stage that may have resulted in prolonging the life
of the cat and improving their quality of life during this time.

     So yes, cats are sneaky. Dogs are much more likely to tell you when there is a problem. Cats
often won’t until they reach a point that they can’t hide it anymore. There may be signs, but they
can be quite subtle. Most symptoms are often chalked up to “normal aging changes”. Even as
veterinarians, we cannot always immediately diagnosis a problem by an exam alone. We need
additional diagnostics such as blood work, x-rays, sometimes ultrasound to be able to assess
your cat’s health and be able to determine a diagnosis and treatment plan.

     It is for these reasons that we believe strongly in the importance of annual exams with our
younger patients (6 years or younger), senior patients (7 through 9) and exams every 6 months
for patients 10 years and older as well as cats that may be under 10 years but have a serious
health concern, such as diabetes or heart disease. Blood work screening is also frequently
recommended to pick up diseases in their earlier stages. Vaccinations are important, and in the
case of the Rabies vaccine, required by law regardless of whether or not your cat goes outside.
What is far more important is the examination and health screening. Remember, just because a
cat doesn’t go outside, that doesn’t mean that they can’t get sick (or have exposure to Rabies).
A thorough veterinarian would examine your cat and make recommendations for additional testing
to screen for some of the more common diseases that we see in cats. We don’t want to wait
until there is an obvious problem, as early detection is your best defense. The number of cats in
households has and continues to outgrow the number of dogs. Despite this, cats receive far
less veterinary care in comparison. It is my goal to change that. Cats are just as deserving of
proper health care and maybe even more so because they will often suffer in silence without it.