DEAR DR. FOX: I have an 8-year-old Tibetan terrier, Jesse; a 4-year-old Maltese, Sophie; and a 2-year-old Maltese, Dylan.

My vet believes that monthly heartworm prevention is necessary. All dogs get Heartgard Plus every month. Even though I've never missed a month, when it gets close to a year, the vet requires blood work for a negative reading before she will approve more medication. The blood work is $45 per dog. The medication is also quite costly. She requires that I sign a waiver for the meds if I do not buy them from her and get them on the Internet.

According to Dr. David Knight and Dr. James Lok of the University of Pennsylvania School of Veterinary Medicine, addressing recommendations for year-round meds, "The practice of some veterinarians to continuously prescribe monthly chemoprophylaxis exaggerates the actual risk of heartworm transmission in most parts of the country and unnecessarily increases the cost of protection to their clients."

What do you think? -- C.Z., Naples, Fla.

DEAR C.Z.: In most states, there are flea/tick and mosquito seasons that justify intermittent use of preventive drugs. But in areas like Florida, it can be a year-round battle. Check my website, DrFoxVet.com, for safer methods of flea and tick control.

If you are confident that you can keep mosquitoes away indoors and out, your dogs may stop taking heartworm medication. But since the Heartgard Plus also keeps other parasites at bay and the low dose is safe for most breeds, it may be wise to continue with the monthly preventive medication.

Use botanical insect repellents such as Organic Orange TKO Natural Cleaner (diluted in water) or a water/eucalyptus oil or lemon oil spritz to keep mosquitoes and other biting insects away from you and your dogs.

We must adopt precautionary principles such as keeping dogs off chemically sprayed sidewalks and lawns and fight the use of such poisons in our communities.

Lymphoma and other cancers, even in young dogs, are the main causes of death in our canine companion animals. I attribute much of this to the toxic environments we have created in our homes and outdoors, where insecticides and herbicides are used routinely and by and large unnecessarily for cosmetic purposes. Also, agrichemical contaminants of human food and pet food play a significant, but impossible to quantify, role in the genesis of cancer, some types being especially prevalent in farmers and agricultural workers.

DEAR DR. FOX: We have a 7-year-old male Russian blue cat, Boris, who weighs 6 1/2 pounds. His weight has remained constant, and, apart from what I am about to describe, he has had no significant health problems.

Boris was adopted when he was a year old, and we noticed soon after he arrived that he periodically choked or gagged and threw up food he had recently eaten or bile. We took him to our veterinarian, who advised that the behavior might be genetic but was no cause for concern.

We feed Boris moist food (Friskies) in the form of shreds or flakes. He's a finicky eater, and he will turn up his nose at one form of food or another, even though he relished it the day before. He also gets treats in the afternoon (Temptations), and he doesn't let me forget to give them to him. He rarely gets tuna, but yesterday we gave him a few bits and some liquid from the can. He ate and drank everything and did not regurgitate it. I tend to believe the treats may be responsible for his problem, but he throws up his regular food too.

Lately, he has been throwing up more often, and he always gags or chokes beforehand. We are wondering whether or not we should discontinue the treats, change his food, provide some sort of medication or simply ignore the problem. -- R.F.T., Bonita Springs, Fla.

DEAR R.F.T.: I receive many letters from people whose cats share the same symptoms as yours and have posted many replies on my website.

I do not like the cavalier attitude of the veterinarian who saw your cat. The problem should not be dismissed as some kind of genetic behavioral quirk of no consequence. I would cut out the treats, consider fur balls in his stomach and urge you to transition him onto a raw food diet or one that is grain- and soy-free.

Your cat most likely has a food allergy or hypersensitivity. There are many other reasons why cats regurgitate their food, from eating too quickly and not being fed four to six small meals a day to having chronic renal failure or fatty liver disease. I would not ignore this problem.

NORTH DAKOTA STILL WITHOUT CRUELTY FELONY

In state elections this November, 65.4 percent of voters in North Dakota voted against Proposition 5, which would have made it a class C felony, punishable by incarceration, to maliciously and intentionally harm a living dog, cat or horse. This measure was aimed at domestic pets, and would have been enforced against instances akin to Michael Vick's dog fighting cruelties, but provided exceptions for veterinarians, hunters, scientists and agriculture workers. North Dakota joins South Dakota as the two states in the nation without animal cruelty felonies.

(Send all mail to animaldocfox@gmail.com or to Dr. Michael Fox in care of Universal Uclick, 1130 Walnut St., Kansas City, MO 64106. The volume of mail received prohibits personal replies, but questions and comments of general interest will be discussed in future columns.

Visit Dr. Fox's website at DrFoxVet.com.)

DEAR DR. FOX: My 11-year-old male cat will eat only dry Kitten Chow. He will sometimes eat cantaloupe when we have it in the summer.

He is a house cat who scratches up furniture and is timid. He has never been ill until lately, and he now has a sore left eye. Forget about changing food -- he tries to bury anything besides Kitten Chow. Is it OK if he continues eating this? I have plenty of fresh water around.

What can I do for the eye? The last cat I took to the vet was so afraid, he died of a heart attack. -- V.T., Poughkeepsie, N.Y.

DEAR V.T.: Considering your cat's age and evident addiction to dry food, try transitioning him onto a dry food that has no corn or soy ingredients. There are several improved brands on the market -- just read the labels. Visit my website, DrFoxVet.com, for names of brands that I recommend.

His eye condition does concern me. He may have an infection or a turned-in eyelash, which could lead to ulceration of the cornea or blindness.

There are veterinarians who make house calls, so check your local Yellow Pages to find one who will come to your home to examine your cat and provide appropriate treatment. Going to the veterinary hospital can be extremely stressful for some cats, and I sympathize with the loss of your other cat. Putting cats in a boarding facility can also be stressful and result in post-traumatic stress disorder. This is why I advise either an early-in-life boarding experience or in-home care for people going away on vacation without their cats.

DEAR DR. FOX: We are concerned about our 2-year-old female Maltese's diet. Last January, she started to vomit and have bloody diarrhea every day.

Our vet put her on Hill's Prescription Diet z/d Allergen Free dog food, and the problem stopped. I am a believer in holistic, healthy food for my Maltese and would like to get her off the Hill's and start a healthy diet for her, but every time I try to change her diet, she has the same problem. When I try to change her diet, it takes about 10 days before she starts the vomiting.

We adopted a Shih Tzu when she was 1 1/2 years old. She will be 3 years old in December, and she cannot digest grains. We think that is why people had to give her up. I have her on z/d as well. -- J.S., Bonita Springs, Fla.

DEAR J.S.: There are several dog food manufacturers such as Wellness, Merrick and Organix marketing grain-free dog foods, and you can try variations of my home-prepared diet posted on my website.

I agree with you that many prescription diets are far removed from organic, whole food dietary formulations, but some are better than others and have a place in holistic veterinary medicine. For special veterinary-formulated recipes for a variety of dog and cat health problems that you can prepare at home from known ingredients, visit balanceit.com.

Remember, when trying any dietary transition with your dog, take about 10 days, removing 10 percent of his regular food and replacing it with the same amount of the new food. Increase in 10 percent increments until it's all the new food. Give him digestive enzymes and probiotics with the food.

(Send all mail to animaldocfox@gmail.com or to Dr. Michael Fox in care of Universal Uclick, 1130 Walnut St., Kansas City, MO 64106. The volume of mail received prohibits personal replies, but questions and comments of general interest will be discussed in future columns.

Visit Dr. Fox's website at DrFoxVet.com.)

DEAR DR. FOX: My 24-year-old grandson got his first adopted dog, a 1-year-old black Lab-mix. He is very protective of her and really takes good care of her.

She had a hot spot and licked it until it bled. He took her to the vet, who shaved the spot and put some kind of cream on it. The vet said he had to anesthetize the dog because he was afraid she would bite him.

Why would he do that? It is a very small spot, and he charged more than $350. I am upset that they took advantage of my grandson and that the dog was anesthetized unnecessarily. Am I wrong? -- N.W., St. Louis

DEAR N.W.: I am receiving too many letters like yours that disturb me deeply.

Your grandson owes it to his dog and to all other animals who may be seen by this veterinarian to file a formal complaint with the Board of Veterinary Examiners. This animal doctor is putting an animal patient at risk and overcharging his client by adding an unnecessary procedure: He used anesthetization rather than simply muzzling or giving a sedative/tranquilizer injection and then physically restraining the dog as needed.

I also question the treatment -- the dog would lick off any ointment put on the hot spot without some protective covering or neck restrainer. If no possible cause of the hot spot was considered (such as flea bite hypersensitivity) and no steps taken to stop the dog from reaching and licking the lesion, I think a full inquiry is called for.

DEAR DR. FOX: Our 6-year-old male seal point Himalayan cat, Jojo, started limping about six months ago. We recently took him to the vet, as the limp seemed to become worse. The physical exam was unable to provoke any pain response, and no swelling was noted. X-rays of the right and left shoulders showed a growth on both approximate to the humerus/shoulder. The growth is considerably larger on the right, and his limp appears to involve the right front side. Unfortunately, I do not have a specific name for this condition and cannot research the diagnosis to obtain alternative care other than a humeral head osteotomy, which has been mentioned by a consulting surgeon as a future possibility, but is not recommended at this time due to a questionable outcome.

Jojo has one capsule of Dasuquin per day. For pain, he can receive a small amount of aspirin every 72 hours. I have not started the aspirin due to potential liver and kidney issues.

We purchased Jojo and his brother, Mokie (who died of fibrocystic kidney disease at age 3), from a private breeder, and we are not aware of any injury or trauma. -- P.V., Kansas City, Mo.

DEAR P.V.: I suspect that your poor cat has a congenital deformity in both shoulder joints, the instability caused by dysplasia of the joints leading to the abnormal bone and connective tissue proliferation. This is how the cat's body is reacting in an attempt to stabilize the joints. The inflammatory reaction may be temporarily alleviated by short-term treatment with steroids.

Long-term benefit may come from anti-inflammatory turmeric and omega-3 fatty acid supplements as provided in fish oils. Discuss sources and dosage with your veterinarian. Organically certified free-range poultry and other meats and dairy products contain more omega-3 fatty acids than conventionally corn-fed and factory farm animals.

Be sure your cat is on a corn- and grain-free diet. I would advise against invasive surgery. My massage therapy book, "The Healing Touch for Cats," may help you make life more comfortable for Jojo with a daily massage. Any discomfort in one part of the body will throw the rest of the body out of balance and possibly lead to secondary injuries. Inform the breeder of Jojo's condition and Mokie's demise.

DEAR DR. FOX: My question concerns the relatively recent advice on cleaning the teeth of cats -- a process requiring anesthesia. If you recommend this for a healthy animal, how often should he or she be subjected to it?

In my childhood, we had many pets over the years, and they all lived long lives. Our cats lived to be 18 to 20 years old, and their teeth were never cleaned. -- M.C., Washington, D.C.

DEAR M.C.: Some will argue that cats in years past did not receive adequate veterinary preventive care. But in years past, many cats were allowed to roam free, killing mice and other small prey that naturally helped keep their teeth clean. Nor were they fed high-fiber, processed ingredients in their diet, like the microparticulate, glutinous materials in many canned and dry (soak them and see!) cat foods.

Regrettably, periodontal and other gum and tooth diseases are all too common in cats and dogs, especially toy and brachiocephalic (pushed-in face) breeds with crammed and misaligned teeth. Neglected, these oral diseases cause animals pain, misery and secondary infections spreading to the heart, liver and kidneys. Inflammatory substances (cytokines) injure the heart, kidneys, pancreas and possibly the joints.

Daily brushing (with equal parts salt and baking soda), safe chew toys, and periodic treatments with specific oral care products -- like those from PetzLife -- will help reduce the need for annual dental cleaning under a general anesthetic. This is a high-risk procedure for many animals and could be avoided by owners taking better care of their animals' mouths.

(Send all mail to animaldocfox@gmail.com or to Dr. Michael Fox in care of Universal Uclick, 1130 Walnut St., Kansas City, MO 64106. The volume of mail received prohibits personal replies, but questions and comments of general interest will be discussed in future columns.

Visit Dr. Fox's website at DrFoxVet.com.)