Seizures in Dogs and Cats

     A seizure is involuntary behavior that is caused by abnormal brain activity. Seizures may involve loss of consciousness, involuntary muscle activity affecting one part of the body, such as the face or whole body, sustained muscle contractions, alternating limpness, stiffness, inappropriate behavior – gum chewing, fly biting or attacking other pets or family members. Some seizures are one time events or may occur repeatedly over the course of weeks or months. The most important clue in determining if your pet has had a seizure or not is if they appear disoriented after the episode. This is otherwise known as the post-ictal phase.

     The causes for seizures differ based upon age and history – young animals causes include low blood sugar, liver shunts or improper brain development. In older pets we become concerned about brain tumors, infections, and/or autoimmune diseases. In both age groups we are concerned about toxin exposure such as chocolate ingestion, recreational drugs, pesticides, flea or tick medications or other infectious causes. Some breeds of dogs develop idiopathic epilepsy (or cause is unknown) – breeds include Labradors, Goldens, Bernese mountain dogs and poodles. Cats however require more advanced diagnostics which include spinal fluid analysis to determine infectious causes (toxoplasmosis) along with imaging.

     Diagnosis starts with a medical history, it is very important to note when your pet had a seizure, the duration, intensity and frequency of the seizure. Laboratory tests are necessary to help diagnose the cause of seizures if there is a cause outside of the brain. Additionally some dogs may require more advanced testing if the problem is located inside the brain. Tests include obtaining a sample of spinal fluid, performing an MRI (magnetic resonance imaging) or CT (computed tomography).

     Some dogs may have a single seizure and may not require further medications. Dogs that require medication have seizures more than once a month, or have had multiple seizures in one day. Medications may cause the pet to be sleepy at the beginning but they will acclimate or become used to the drug over time. Many pets remain on antiseizure medications for life and require regular serum drug levels to ensure proper drug dosaging to prevent seizures from “breaking through.” If your dog has a seizure longer than 5 – 10 minutes or is in a state of continuous seizures these dogs need to be seen by a veterinarian immediately.

Caroline Li, DVM

Ear Infections in Cats and Dogs

     Ear disease is one of the more common diseases in dogs. Infection of the ear or otitis can occur in the external or middle ear. Clinical signs of ear infections include – head shaking, scratching at the ears, a stinky ear, discharge, swelling or redness of the skin inside the ear. Not all red ears are infected ears, however, if they are left untreated it can become infected.

     The normal ear is a structure made up of cartilage that is lined with skin, hair follicles, sebaceous (sweat glands) and modified ceruminous (wax forming) glands. Normally the skin cells and glandular cells produce wax to trap dirt and debris in the ear canal. The normal ear canal is smooth, light pink, with a pearly appearing tympanic membrane.

     The development of ear infections can be divided into predisposing, primary and perpetuating factors. Predisposing factors include the environment such as moisture and or heat, hair plucking, grooming powders and/or anatomic variation; floppy ears (like cocker spaniels), stenotic or narrow ear canals (like the sharpei), and the number of wax/ glandular cells, and number of hair follicles lining the ear canal. Other predisposing causes include hormonal or autoimmune diseases.

     Primary causes include foreign bodies (foxtails), cancer, ear mites, food/inhaled allergies, endocrine or autoimmune diseases.

     Perpetuating factors – these are causes that make treatment challenging and prone to failure –include bacterial or yeast infections, chronic changes to the structure of the ear from inflammation or deep infection, or inappropriate treatment.

     Determining ear infections begins with an otoscopic examination – to assess the surface of the ear canal and to determine if the ear drum is intact. Next is obtaining a sample of the material in the ear by rolling the exudates (wax) onto a slide. There we look for yeast and/or bacteria or even parasites!

     If bacteria or yeast are seen, we need to clean out the ear wax and debris using a special ear cleaner. In order for a medication to work and adhere to the skin in the ear, we need to start with a clean dry ear. If some infections are very deep we may need to add oral antibiotics and steroids to decrease inflammation.

     Maintenance ear care prevents ear infections from occurring again. Depending on your veterinarian they may recommend routine ear cleanings with an appropriate cleaner and medication. Over cleaning can also predispose our pets to developing ear infections by disrupting the normal microenvironment in the ear. Successful treatment of ear infections require identification of the primary cause (allergies, foreign body, autoimmune, endocrine diseases etc), and choosing the appropriate antibiotic along with regular visual assessment of the ear canal and tympanic membrane by your veterinarian.

Caroline Li, DVM

Feline Idiopathic Cystitis (FIC)

     Feline idiopathic cystitis (FIC) is an inflammatory disease of the bladder that is fairly common in cats. This condition has also been referred to as feline lower urinary tract disease (FLUTD) and feline urologic syndrome (FUS). Cats with this disorder will have various clinical signs related to abnormal, painful urination. It is important to learn about FIC so that you can recognize if you cat is having problems at home and needs medical attention.

     The definitive cause of FIC is unknown, but various risk factors have been identified which make certain cats more prone to the disease than others. Most cats with FIC are indoor kitties that eat dry food, are members of multi-cat households, and may have had a recent stress in their life (new pet introduced, moving, etc). Often times, they are overweight and may have other medical conditions. The most common age of onset is between 2-6 years old, though cats of any age can get this disease.

     Cats with FIC show various clinical signs related to abnormal, painful urination. They may strain in the litter box, pass small amounts of urine frequently, or have bloody urine. Some cats will urinate outside the litter box.

     If your cat is showing the above signs, they should be evaluated by a veterinarian. A physical exam will be performed and blood and urine tests may be recommended to rule out medical conditions like kidney disease or urinary tract infections. An abdominal ultrasound may be needed to look for bladder stones or other abnormalities that could be causing your cat’s problems. If none of these tests diagnose a problem, then your cat is likely suffering from FIC.

     Dietary modification is the most important component of treatment. Your cat should have free access to water and should be encouraged to drink. It may be helpful to provide a pet water fountain or allow a faucet to drip because many cats prefer running water to drinking from a bowl. Your cat should also start eating wet (canned) food and may require a special urinary tract diet – ask your veterinarian for details.

     Treating FIC also involves lifestyle changes for your pet. Reducing environmental stresses is an important component to treatment. There should be at least 1 litter box for each cat in the house and they should be easily accessible and in a safe, quiet place. New pets should be introduced gradually to allow time for your cat to get used to their new friend. Environmental enrichment is also an important component to decreasing stress. Toys and climbing posts help give your indoor cat opportunities for exhibiting their natural behaviors. Pheromone therapy may be helpful in conjunction with environmental enrichment. Pheromones are chemicals like hormones that are used for inter-animal communication. Products like Feliway® may help decrease anxiety for your kitty and are available as room diffusers or sprays.

     If diet and lifestyle changes are not sufficient to decrease your cat’s clinical signs, medical therapy may be indicated. There are drugs available to help with inflammation, bladder control, and anxiety. Your veterinarian will prescribe whatever medications are necessary to make your cat as comfortable as possible.

     It is important to distinguish FIC from a lower urinary tract obstruction. Male cats are predisposed to lower urinary obstructions because their urethras are very narrow. Stones or mucus can get plugged in the urethra and block the flow of urine that is trying to leave the bladder. A urethral obstruction is a medical emergency that requires veterinary attention immediately. If you are ever concerned about your cat’s health, please contact a veterinarian for advice.

Kerry Thode, DVM

Why is My Pet Eating Grass and Plants?


     The answer for why many dogs and cats eat grass and other plants is not clear – cut. Some of the more popular theories are that they have a deficiency in diet, need for more fiber, or that it is a natural instinct inherited from ancestors to rid the body of intestinal parasites. Recent research suggests that most pets eat grass when they are not showing signs of illness. In a recent study conducted at UC Davis by Karen Sueda and her colleagues, it was reported that only 9% of dogs appear ill prior to consuming plant material and only 22% were seen vomiting afterward. It also suggested that younger animals tend to eat plants more often and less frequently appeared ill before plant – eating. Younger animals also have an increased likelihood of consuming other non- grass plants.

     If your pet is consuming plant material, it may be normal behavior. If your pet has other signs of illness, please consult your veterinarian. Your pet should have a complete physical exam to rule out any underlying illnesses.

     The following is a short list of some common toxic plants. If you suspect that your pet has consumed these or other toxic plants, please consult a veterinarian immediately:
Oleander
Castor beans
Lillies
Pothos
Cyclamen
Marijuana
Cycad palms (Sago palm)
Azalea/rhododendron
Schefflera
English Ivy
Peace lily
Chrysanthemum
Autumn crocus
Tulip/narcissus bulbs
Amaryllis
Yew

Lacey LaVigna, DVM

Importance of Vaccines

      Vaccinations are an important component of pet healthcare and also play a key role in the control of disease at the national and global level. Vaccines are designed to strengthen an animal’s immune system against a certain disease, to either prevent or minimize the effects of that infection, should the animal later be exposed. They consist of either modified or killed forms of the microorganism. Vaccine guidelines have been created for our pet population and generally consist of “Core” vaccines, which every animal should receive, and Non-Core” vaccines, which are given depending on life style. However, the most important component in vaccine management is consulting with your veterinarian so they can create a vaccination plan specifically tailored to your pet.

      You may have wondered why puppies and kittens receive a series of vaccinations. Young animals have naturally occurring immunity to disease, which they receive from their mothers during pregnancy and while nursing. This natural immunity begins to breakdown over the first few months of life, putting the puppy or kitten at risk for disease. For an animal to mount their own immune response, and for a vaccine to be effective, the naturally occurring immunity must be gone. We don’t know the exact point that any given animal will lose their natural immunity, and be ready to mount their own individual immune response, so a series of vaccines are given to ensure we don’t put a young animal at undue risk for disease, but also are able to impart long term immunity. For this same reason it is important not to exposure your puppies and kittens to animals with uncertain vaccination history, or environments where sick animals may have been, until their vaccine series is completed.

      There are two “Core” vaccinations given to dogs. The first is rabies, which is required by law due to its potential to spread to human beings. The second is DAP, which is a combo vaccine which protects dogs from some very serious viral diseases, including parvovirus and distemper. Several “Non-Core” vaccines for dogs exist which you and your veterinarian can decide upon based on your pets lifestyle and the diseases they may be at risk of contracting.

      “Core” vaccinations for cats include rabies, and the combo vaccine FVRCP, which primary is designed to cover cats for upper respiratory infections. One of the primary “Non-core” vaccines for cats is Feline Leukemia Virus, a life threatening disease which outdoor cats are at risk of contracting.

      Veterinarians would agree that the benefits far outweigh the risks. About 1 in every 200 animals will have an adverse vaccine reaction, but most reactions are very mild. Most vaccine reactions are limited to pain at the injection site, but they can also include facial swelling, hives, vomiting, diarrhea, and in rare causes anaphylaxis and shock. Some cats can also develop cancer at the site of injection years after their vaccination, but this condition is rare (about 1 in 10,000) and modern vaccines put cats at less risk.

      Although there are risks associated with vaccinations, they are an important tool available to your veterinarian to prevent serious and often life threatening disease in your pet. Vaccines are also largely responsible for controlling and even eradicating several of the world’s most serious infectious diseases, in both people and animals. By working with your veterinarian a vaccination plan can be made to minimize risk and keep your pet protected.

Trevor Miller, DVM

Beyond Separation Anxiety: Part 4, The Grand Finale

     It’s hard to believe I have been able to cover so many differentials for behaviors associated with separation anxiety in just 3 blogs! The only other differential I want to briefly mention is predatory behavior. Destructive behavior (and even vocalization) can be seen when the dog is trying to get to prey; which could be in the form of rats behind the walls! The treatment is to remove the source as predatory behavior is different from other behavior problems in that it is not very amenable to behavior modification. Dogs are either born with it or not, making the prognosis poor for changing the underlying emotional response.

     In the first blog of this series, we discussed the signs for separation anxiety, so in this blog we will focus on what can be done about it! Confirmation of appropriate diagnosis is important. Separation anxiety is one of the most difficult behavior problems to treat as it is often extremely difficult to avoid leaving the dog home alone for most people (myself included). Like other behavior problems, the more the dog practices the behavior, the more difficult it is to change. Since not leaving the dog home alone for months and months while behavior modification is implemented is not realistic for most people, anti-anxiety medications may be prescribed by your veterinarian to facilitate this process. If the pet does need to be left alone, they should be left in the place they are most comfortable with multiple long lasting treats they can safely consume in your absence. The Kong Company has some great ideas for different long lasting treat recipes (http://www.kongcompany.com/recipes/). The dog should always be ignored for 10-15 minutes before leaving and until calm once the owner returns home in order to decrease the emotional highs and lows of these times.

     A key component to treating separation anxiety is to change the dog’s emotional response to being away from the owner. To do this, the dog first must be comfortable with the owner being in a separate part of the house. This is accomplished by implementing independence exercises. The dog is put on a mat with a favorite long lasting treat. Over many sessions the owner practices moving further away for longer periods of time. If the dog is not sleeping or relaxed and eating their treat, then the time and/or distance must be decreased during the next session. After many weeks, once the owner is able to walk around the house for 10-15 minutes out of sight of the dog, graduated departures can be started. This is an extension of the independence exercises with the owner being able to walk out the door for 1 second initially, working up to longer and longer (hopefully hours) periods of time. The long lasting treat should be picked up when the exercise is over so that your dog is rewarded for your absence, not presence. Using a video camera helps to monitor your progress once you are out of sight of the dog.

     Another part of behavior modification for separation anxiety is uncoupling the cues that tell your dog you are leaving from your actual departure. This involves practicing the cues when you are not actually leaving. For example, pick up your keys and then go wash the dishes or put your shoes on and sit down to read a book. Over time you can do more and more cues together until you are able to work up to a whole day’s routine without leaving. Remember that these are general recommendations and each individual patient should have a treatment plan devised by a Veterinary Behaviorist or Certified Applied Animal Behaviorist for safety reasons and the best outcome.

    Well, that’s it for my discussion of separation anxiety. Stay tuned for more behavior blogs. If there is a particular topic you are interested in please let us know!

Meredith Stepita, DVM, DACVB (Veterinary Behaviorist)

New Puppy or Kitten?

      It finally happened. Your children won the argument and you came home with a new puppy or kitten. Everything was peachy – then it all started to happen: the kitten decided to use your great-grandmother’s rug as a litter box and scratching post, or the puppy found your beloved vinyl records of Elvis or the Beatles and destroyed them with such efficiency, that an industrial shredder would be jealous. You’re now over your head with this young creature. Now what?

     Bringing a new puppy or kitten into the household is not as simple as walking down to the shelter, picking out the cutest animal, and then bringing it home. Time must be spent before ever bringing a new pet home. Most parents don’t have a baby without some sort of pre-planning and preparation, right? The same applies here.

     Research the breed that you are interested in getting. Some breeds are better suited to your family’s lifestyle than others. An owner who doesn’t like to walk or can’t exercise will not fit well with a dog who likes to run a lot. The same is true for certain breeds of cats: some cats require a lot of attention and talk a lot, and some owners might not like that.

     Make sure you have all your supplies beforehand. Crates, chew toys / scratching posts, water / food bowls, appropriate food for the age of the animal and grooming supplies. A leash, collar and ID tags are a must.

     Is your house set up properly? You need to find a place for the crate and sleeping areas. Designating a potty area should be done as soon as your puppy comes home. Kittens need to be introduced to their litter box right away. Put away items that you do not want destroyed.

     Routines work well with animals. Work with your puppy or kitten from the beginning to establish a routine for eating, playtime and exercise. Establishing good habits early on will save you trouble later on down the road.

     Your first visit to the vet can be overwhelming with the amount of information you will receive. The following is a list of typical topics:
          1.Vaccines and diseases
          2. Controlling parasites, both internal and external
          3. Nutrition
          4. Insurance
          5. Behavior – house training, biting, contact with children / other pets
          6. Problems commonly associated with certain breeds
          7. When to spay / neuter
          8. Dental care and grooming
          9. New puppy / kitten kits

     Vaccines are obviously an important topic at the beginning of any puppy or kitten’s life. While there are some risks involved with giving vaccines, the benefits far outweigh the risk. However, anytime an animal receives a vaccine, regardless if it’s the first time or the 10th time, some signs may occur, such as swelling, pain, a low grade fever, or lethargy. More serious reactions, such as anaphylactic shock, can also occur. In cats, a reaction called a vaccine associated sarcoma (a cancerous tumor) may also occur, but this is also infrequent.

     There are a number of required, or core vaccines given to puppies and kittens. Additionally, there are other vaccines that can be given, based on you and your pet’s lifestyle (close contact with wildlife, frequent boarding, for example).

The core vaccines and their schedule for dogs:
          1. DHPP – distemper, canine infectious hepatitis, parvovirus, parainfluenza virus
               a. These viruses can attack the liver, heart, respiratory tract, central nervous system and the intestinal tract
               b. Initial vaccine at 8 weeks, then boosters at 12, 16, 1 year 4 months, and then every 3 years after that.
          2. Rabies – a virus that attacks the brain, spread by being bitten by an infected animal
               a. Initial vaccine at 16 weeks, a booster at 1 year 4 months, and then every 3 years after that.

Lifestyle vaccines for dogs can include:
          1. Leptospirosis – a bacterial disease that is spread by contact with urine from infected wildlife. Can be spread to humans. Can cause liver and kidney disease.
               a. Initial vaccine at 12 weeks, then boosters at 16, 1 year 4 months, and then every year after that.
          2. Bordatella (kennel cough) – a bacterial disease that can cause respiratory illness, commonly caught at dog parks, grooming facilities or kennels.
               a. Initial vaccine at 12 weeks. Boosters every 6 – 12 months.
          3. Rattlesnake – helps decrease the severity of rattlesnake bites.
               a. Initial vaccine at 12 weeks. Boosters every year thereafter.

The core vaccines and their schedule for cats:
          1. FVRCP – feline viral rhinotracheitis, calicivirus, panleukopenia virus
               a. These viruses can attack the respiratory and intestinal tracts. They are spread in the air or by close contact with an infected individual.
               b. Initial vaccine at 8 weeks, then boosters at 12, 16, 1 year 4 months, and then every 3 years after that.
          2. Rabies – a virus that attacks the brain, spread by being bitten by an infected animal
               a. Initial vaccine at 16 weeks, and then every year thereafter.

Lifestyle vaccines for cats can include:
          1. FELV – feline leukemia virus
               a. This virus can cause immunosuppression (decreased ability to fight other infections) and death in cats of all ages. It is spread by contact with infected individuals.
               b. Initial vaccine at 12 weeks, then a booster at 16, and then every year thereafter.

     Getting a new puppy or kitten can be stressful, but don’t worry, you’ll get through it. It requires patience, discipline, and sometimes the ability to step back and calm down. Don’t worry, you’ll do great with a new member in the family!

Byron Bowers, DVM

Beyond Separation Anxiety: Part 3, Why is My House Yellow?

Another common symptom of separation anxiety is urination and/or defecation in the house. First, all medical causes (I.E. intestinal parasites, urinary tract infections, etc) need be ruled out by visiting your veterinarian. Then, other behavioral causes should be ruled out.

Regarding urination, we must differentiate between urine marking (usually small amounts of urine on vertical surfaces) and inappropriate urination (usually large amounts of urine on horizontal surfaces). Urine marking can be due to hormonal causes in intact animals as well as anxiety and territoriality. Castration decreases marking in 70-80% of male dogs, regardless of the age of castration. Behavioral causes of inappropriate urination include management issues (I.E. home alone too long without access to an elimination area), substrate preference (carpet!), location preference, substrate or location aversion (bad weather), inadequate or lapse in house training, excitement urination, and submissive urination. Except for the last 2 causes, the same differentials apply to inappropriate defecation.
The first important step in treatment is to prevent situations that elicit the behavior. For example, a territorial pet that marks when people and dogs pass the house can be prevented from watching triggers through the window by pulling down the blinds or using wallpaper for windows (http://www.wallpaperforwindows.com/pc/home.asp). Also, dogs tend to mark new objects in the house, so keep these objects out of the dog’s reach. For example, avoid leaving a grocery bag or back pack on the ground when you walk in the door with your hands full. Instead, keep these items out of reach of the dog. Urinating and defecating are normal behaviors, so avoid punishing your dog. Punishment will also make the anxiety worse and the dog will not associate the punishment with the behavior if punished more than 1 second after the behavior occurred. Make sure to clean elimination in the house with a combination enzymatic/bacterial cleaner to degrade the urine rather than simply covering up the smell (my favorite is Anti-Icky-Poo, http://www.antiickypoo.com/). A belly band, which is essentially a male diaper, can be used as a short-term solution as long as it does not cause a cause skin infection. In some cases, anti-anxiety medication may be indicated.

If house training is the problem, here are some tips to help your dog be successful: Supervise your dog at ALL times, even keeping a leash on your dog and holding the leash. The dog should have one month without accidents in the house before allowing gradually increasing access to the house. When not directly supervised the dog should be confined. Take your dog outside to eliminate after waking up, coming out of the kennel, playing, eating, and right before bed. Initially take the dog outside every 1-2 hours and gradually increase the time over several weeks to months as they are successful. When you take your dog outside to eliminate pick a spot and wait there until your dog eliminates. Timing is important, so immediately after eliminating reward the dog with praise and a treat.
Dogs with excitement and submissive urination should be completely ignored when they are likely to urinate. Dogs often outgrow these behaviors as they reach adulthood, but may need specific desensitization and counter-conditioning protocols to change their emotional response to triggers for the behavior.

This is not an exhaustive explanation of treatment for all of the causes for urine marking and inappropriate elimination, but it’s a good start. Stay tuned to future blogs for an explanation of other causes or email us if there is a specific cause you would like discussed in more detail in a future blog.

Meredith Stepita, DVM, DACVB (Veterinary Behaviorist)

Your Pet and Their Anal Glands

What are anal glands?
Anal glands, or anal sacs, are normal structures of the canine and feline anatomy. These two glands are located at the 4 o’clock and 8 o’clock position beneath your pet’s anus. They become expressed naturally as a scent marker during natural defecation. Also they can be expressed during times of extreme fear or danger as a self defense mechanism.

What are common anal gland problems?
In some individuals, anal glands fail to express naturally and tend to fill up with glandular material that may become thickened. These glands become impacted and can be bothersome to your pet. Clinical signs you may notice are a “scooting” of the bottom on the ground or more subtle symptoms such as licking of the hind end, pinning of the tail down, or any behavior that indicates discomfort. If anal glands are impacted for long periods of time they may become infected, which can lead to abscess formation. If your pet has an anal gland abscess you may see a hard, warm swelling in the area. Abscesses require medical attention; if you see any signs of anal gland disease please schedule an appointment with your veterinarian so that your pet may receive proper care. Treatment may include sedation and placement of a temporary drain. Oral and/or injectable medications will likely be prescribed as well.

Manual expression
Anal glands can usually be expressed digitally. In some pets the glands may be expressed by applying external pressure. If an individual has thicker more pasty glandular material, he/she may require an internal expression technique. During this technique, a gloved (lubricated) finger is inserted just inside the rectum and the anal gland is expressed with more direct pressure.

If your pet has ongoing instances of anal gland impaction and/or abscessation, your veterinarian may recommend that your pet have his/her glands manually expressed on a regular basis.

If an animal suffers from severe chronic anal gland problems, he/she may need to have an anal sacculectomy. This means that the anal glands are removed surgically.

Management
Obese and overweight pets are predisposed to anal gland disease. Be sure to maintain your pet’s weight properly. Adding fiber to your pet’s diet will help to minimize this type of problem. Fiber helps to create well – formed stools and support weight control by making him/her feel full for a longer period of time. Please consult your veterinarian about the best diet for your pet.

Lacey LaVigna, DVM

Kennel Cough in Dogs

       Kennel cough is an infectious respiratory disease of dogs. The more scientific name for the disease is canine infectious tracheobronchitis. Kennel cough is usually caused by a bacterium called Bordetella, but other bacteria and certain viruses can also play a role in the disease.
       Clinical signs of kennel cough include a hacking, honking cough that is usually not productive. Dogs generally continue to act normally (eating, drinking, active) but have a persistent cough that can last for several weeks. Dogs spread kennel cough to each other through the air with small particles being passed from one dog to the other. Usually, dogs catch kennel cough in crowded areas where lots of other dogs are present such as boarding kennels, grooming salons, or dog parks.
       Cases of kennel cough usually resolve on their own, but antibiotics and cough medications can help your dog recover more quickly. It may also be helpful to use a harness instead of a collar and leash because putting pressure on the trachea (windpipe) can make coughing worse. It’s best to see your veterinarian if your dog is showing signs of coughing because there are many other diseases that can cause a dog to cough, some of which are serious and require rapid medical care.
       Though kennel cough cannot be 100% prevented, there are vaccines available to help decrease the chance of your dog getting sick. The two most common types of vaccines are an injectable form (given under the skin) and an intranasal form (given in the nose). Talk with your veterinarian about which is best for your pet.

Kerry Thode, DVM