What’s Up With My Dog’s Breath?

“You have dog breath.” — “Why, thank you!”

The term ‘dog breath’ conjures up a rank sour aroma in our minds, powerfully repelling. This is one of the great injustices in animal health care today. The term ‘dog breath’ unfairly creates the idea that bad breath is an unavoidable truth for our four legged companions, but this is far from the truth!

An overwhelming majority of pet owners do not employ any type of home oral hygiene routine for their cats or dogs. What would happen to your teeth or your breath if you didn’t brush your teeth for a month? Now, what would happen to your mouth if you didn’t brush your teeth for 2 years? 7 years?
10 years? This is what we are subjecting our pets to. ‘Dog breath’ should more appropriately be called ‘lack of appropriate hygiene breath’ or ‘medieval breath.’ Animal dental care has lagged heavily behind animal health care for far too long.

Fresh smelling breath is not the only reason that we should turn our attention toward animal dental hygiene. Research in humans and animals alike is linking dental disease to systemic diseases. Current research provides us with evidence for associations between periodontal disease and systemic diseases (heart disease, kidney disease, respiratory disease,
etc) and some research has shown improvement in systemic disease following treatment for periodontal disease. Further research is needed to determine the full extent of the relationship.

Hmm, maybe I should start doing something for my pet’s teeth, but does it have to be brushing? What about all of the dental foods, treats, chew toys, water additives, wipes and sprays? As a veterinarian, I get asked this question often. My response is this, if there were a treat, a spray, a water additive, or something that was easier than brushing but just as effective, would we still be brushing our own teeth? Some of these things help, just like carrots and apples are good for our teeth, but there is no replacement for brushing.

How often should I brush my pet’s teeth? Is once or twice a week enough?

Every little bit helps and the more you brush your pet’s teeth the better but consider this, plaque hardens into tartar in 24-36 hours. Daily brushing is the best way to help prevent dental disease from developing and to prolong the interval between regular dental cleanings.

Okay, but who has the time to brush their pet’s teeth everyday? Brushing your pet’s teeth doesn’t need to be as time consuming as brushing your own teeth. You only need to focus on brushing the outside of your pet’s teeth.
The insides of their teeth accumulate tartar at a much slower rate than the outside of their teeth as a result of the action of the upper teeth moving against the outside of the lower teeth and the action of the tongue moving against the insides of the teeth. To brush your pet’s teeth effectively, you need only hold their mouth closed and lift their lip on one side, put the brush against the molars at the back of the mouth and brush in circles to the front of the mouth. Then switch and do the same thing on the other side. The whole process should take about 15 seconds.
That’s 90 minutes a year to give your pet a happier, healthier, longer life!

If you’re still on the fence about this whole brushing thing, consider
this: the cost of a dental procedure can range between a few hundred dollars and several thousand dollars, depending on the rates of the veterinary clinics in your area and the amount of oral surgery (extractions, etc) that your pet requires. Let’s pretend, for the sake of argument, that every time your pet has a dental procedure, it costs $500 and your pet has a dental procedure yearly (some pets, just like people, need to see the dentist more frequently, some less frequently). Now, let’s estimate that brushing your pet’s teeth daily will extend the interval between dental procedures to a year and a half. That reduces the cost of dental procedures from $500/year to $333.33/year… a savings of $166.67/year. That’s $166.67 for approximately 90 minutes of work. These numbers are very rough estimates and are on the low end of the spectrum, but you get the idea. Some people need to see the dentist every 6 months despite daily brushing and some people do fine for years. The same goes for our pets. My own dog goes about 3 years after a dental cleaning before I notice any ‘dog breath.’ In fact, people that meet my dog often comment, “Wow, her breath doesn’t smell at all.”

One more benefit that can’t be ignored – less frequent anesthesia.
Although anesthesia is far less risky than it once was and the risk of complications is low, reducing the number of times a pet has to go under anesthesia is a nice benefit. This is of particular value for pets with diseases that put them at higher risk for anesthesia, such as heart conditions, kidney disease and liver disease.

What about anesthesia-free dentistry? This is a topic that deserves its own focus, but the bottom line is this: more than 50% of a tooth is below the gum line and anesthesia-free dentistry can only address part of what is above the gum line, leaving significant dental disease unaddressed.
Anesthesia-free dentistry is cosmetic only, with no real health benefit.
For more information on anesthesia-free dentistry (also called non-professional dental scaling) refer to the following website:
http://www.avdc.org/dentalscaling.html

What can I do today to start taking care of my pet’s oral health?
Call your veterinarian and schedule a consult for a dental procedure. If your pet already has significant dental disease, brushing now will cause pain and may make your pet averse to brushing. Have a dental procedure performed by your veterinarian before you start brushing your pet’s teeth so that you are starting with a clean slate.

Renee Hartshorn, DVM

EMPLOYEE OF THE MONTH: November 2014

JT (Patient Care Team)
Nearly 3 years ago, Jen “JT” Tsutsui joined the patient Care team here at Encina Veterinary Hospital. At the time she was looking to expand her horizons and saw Encina as a fit for her.

As a veterinary technician on the patient care team, JT spends most of her time assisting and caring for our patients. Blood draws, sedations, radiographs, chemotherapy, assisting with managing the lab equipment and outpatient services are just a few of the things you can catch her doing day-to-day.

JT says she loves working here because “every day I get to do different things”. She attributes her success to liking the people she works with: “I enjoy working with the doctors and staff”.
She admits her greatest challenge here is also one of things she loves the most – “Keeping up with the busy days can be crazy”.

When she heard she had won this month’s EOM, she says she was “very ecstatic, I was surprised”.

Outside of Encina, you can catch her spending time with her family, especially her two little ones or on the softball fields.
“Let it Go” from the Frozen soundtrack is her go-to song to sing-a-long to.

Should she have the luxury of inviting whomever she wants to a dinner party she says, “All my grandparents who have passed away – a grandparent reunion!”

Why Wont My Cat Use the Litterbox?

      Cats can urinate outside the litterbox for many reasons… a frustratingly large number of reasons. Some cats will posture to urinate in a normal way then will typically “bury” the urine spot afterwards. If this is on your floor, then they are probably just making the burying motion with their paws around the spot, but are not actually burying anything. The alternative to this would be marking or spraying, and they are doing just that, “marking” what belongs to them. When cats do this they typically have backed themselves up against a wall and spray urine on it while they are standing and their tail is straight up. This is most common in intact male cats, but neutered males and females will do it also. The very basic reason that cats will do each of these (with the exception of the intact male) is the same: the cat is displeased about something and is feeling stressed out. Remember dogs have owners, but cats have staff. And cats generally let you know when something is not to their liking.

      The first step is to make sure that there is not a medical reason for your cat to be urinating outside of the litterbox. Some medical conditions cause cats to urinate large amounts which can cause them to occasionally not make it back to the litterbox in time before they have to go. Alternatively, they can develop bladder inflammation or stones that cause them to have difficulty urinating or have painful urination. If this is the case, then a cat may have had a painful experience in the litterbox and then choose to avoid it in the future. The veterinarian will likely want to test your cat’s urine +/- blood and do some imaging of the bladder.

      If it is determined that your cat has no medical concerns, the next step is to make sure that the cat is happy with her litterbox. Litterboxes are not fun for pet owners to clean, but cleaning urine out of your carpet is much much worse. First of all there should be at least one litterbox in your house for every cat, and every litterbox should be scooped at least daily. Cats are very clean creatures, and a dirty litterbox can be off putting. Some cats prefer for the litterbox to be cleaned multiple times a day. Cats often also prefer litterboxes that aren’t covered and clumping litter. The box should be large enough for the cat to get in all the way, head to tail, comfortably. The litterbox should be in a place where there is some privacy and no loud noises that might startle the cat while they are using it, such as a washing machine or furnace. Inter-cat aggression can also be a reason that a cat may not be using a litterbox. Sometimes one cat will keep another cat from being able to get near the litterbox, another reason that it is important to have multiple boxes in your home. Remember that if anything negative happens within the box, that your cat will be more wary about using it in the future.

      But cats need more than a beautiful litterbox to be happy and mentally healthy. First of all, cats need somewhere to scratch. This is a natural behavior for a cat and they should be provided with an assortment of horizontal and vertical scratching opportunities. They need a place to rest where they feel safe. They need a cozy place in a back bedroom or den that they can relax and not be startled. Being high up makes cats feel safer as well, so having a perch for your cat can decrease stress, and some perches or resting places need to have a view outside. A view of the birds outside in the tree can be great entertainment, but your cat needs toys so they can play inside the house too. Playing with your cat is important to provide a chance for them to practice normal hunting behaviors, to provide your cat with exercise, and as a bonding opportunity between you and your cat. Some cats are very particular in the types of toys that they like to play with. Take the time to find out what they like.

      Next we need to make sure that your cat is not stressed by anything else in the home. Cats do not like changes in their lives, and any change such as a new animal, new baby, moving, or change in your work schedule can be extremely stressful. Try your best to make any of these changes slowly and try to keep the routine as normal as possible for your cat. For more ideas on any of these specific situations or anything about cat or dog emotional needs, please reference the website at the bottom of the page.
Finally some cats need a little extra help. Feliway is a product that is a synthetic version of the feline facial pheromone. This is what cats are spreading on the furniture when they rub their chins on it. It says to the cat that they are in a safe and familiar place. Feliway comes in sprays in diffusers. They can be located near litterboxes or in locations where a cat is marking. And some cats need oral anti-anxiety medication. Some anti-anxiety medications are very effective in decreasing marking behavior.

Please reference the website indoorpet.osu.edu for more information on making a happy and healthy home for your cat (or dog!)

Erin Clark, DVM

Emergency Preparedness for Pets

Medical emergencies can be terrifying, especially when the emergency involves your pet. Being prepared for an emergency ahead of time can not only make the situation less scary but can even improve your pet’s chances for making a full recovery. In some cases, being prepared can save precious time and mean the difference between life and death for your pet.

Every pet is different and you, as the owner, are in the best position to notice when something abnormal is going on with your pet. Signs that something is serious and your pet should be evaluated ASAP can range from vague signs (lethargy, inappetence, panting excessively) to more obvious signs (vomiting, diarrhea, seizures, collapse, trouble breathing, lameness, inability to stand, etc). If your pet is obviously sick, it should be evaluated by a veterinarian as soon as possible. There are some things that you can do to help make the process more efficient and to help your veterinarian provide the best care for your pet as quickly as possible.

When is an emergency really an emergency? When in doubt, call your primary care veterinarian or an emergency clinic if it is after hours. Veterinary clinics receive calls frequently from clients asking about whether the current clinical signs are enough to warrant an emergency trip to the veterinarian. The staff are usually very good at asking the right questions to determine whether your pet should be seen right away.

What can I do to be prepared?

Phone numbers! Keep the number and address for your pet’s primary care veterinarian and the emergency veterinary clinic in your area in an easily accessible place. If you do not know which emergency clinic to take your pet to, ask your veterinarian for a recommendation or go to the Veterinary Emergency and Critical Care Society website (www.veccs.org) and click on the directory link for emergency clinics. If you think your pet is sick, don’t wait to call! Waiting can lead to bigger problems, a more challenging disease or problem to treat and more expensive treatment. You should also keep the number for poison control with your list of emergency numbers. If your pet has ingested a potential toxin, call poison control before or when you arrive at your veterinarian’s office. It is usually less expensive for you to call poison control than if your veterinarian calls. When you call poison control, you will receive a case number. Give this number to the veterinarian seeing your pet. Your veterinarian will then be able to call poison control and discuss the case with a toxicologist without being charged another fee.

Medical record and current medications: Keep a copy of your pet’s medical record (including all bloodwork, test results, CDs with xrays, etc) on hand to bring with you. If your pet is seeing a veterinarian other than your regular veterinarian, it will be very helpful for the veterinarian evaluating your pet and preparing a treatment plan to have access to your pet’s previous medical records. You should also keep a list of all current medications, doses and frequency. This is very important information for your veterinarian to know so that they can make appropriate treatment decisions (some medications can cause serious side effects if used together!).

For further information on being prepared for pet emergencies, visit the following websites:
• American Animal Hospital Association (AAHA)/Healthy Pet: https://www.aaha.org/pet_owner/pet_health_library/general_health_care/default.aspx
• The University of Illinois College of Veterinary Medicine: http://vetmed.illinois.edu/petcolumns/petcols_article_page.php?OLDPETCOLID=530
• American Red Cross: http://www.redcross.org/prepare/disaster/pet-safety
• VeterinaryPartner.com: http://www.veterinarypartner.com/Content.plx?P=SRC&S=1&SourceID=20
• AVMA First Aid Tips for Pet Owners: https://www.avma.org/public/EmergencyCare/Pages/First-Aid-Tips-for-Pet-Owners.aspx

Renee Hartshorn, DVM

Employee of the Month for August 2014: Melanie!


Nearly 4 years ago, Melanie Grajeda joined the Doctor’s Assistant team here at Encina Veterinary Hospital. Since then, she’s been non-stop – “filling prescriptions, calculating doses, rooming patients, creating and reviewing estimates and client communication” – are just a few things she manages each and every day.

Before Encina Melanie says, “I hated my job because I was working in a small general practice hospital and after working in emergency for 3 years, I needed something busier!” Well she got her wish! “I LOVE how busy it is, how much I learn every day, all the different cases we see and I really like my coworkers”.

She attributes her success here to her beloved ability to “thrive in a chaotic environment” because she “loves to learn and I am more efficient when it’s busy than when it’s slow because I am just the right amount of crazy”.

Although she loves it here, she does admit there is a challenge: “I am super controlling and neurotic and a little bit obsessive compulsive so I have trouble sharing tasks and knowing when to say ‘enough is enough’”.

Outside of Encina, Melanie admits to being a lady of leisure, to an extent. “I have another job outside of Encina but when I’m free from both, I like to go to A’s games, hang out with friends and explore the city of Oakland.”

If you’re dreaming of a serenade from Melanie, be sure to turn on “Don’t Stop Believing” by Journey or anything by Queen as she can’t help but sing along to either.

For her dinner party dreams, Melanie hopes to invite Freddy Mercury, Johnny Cash and her living grandfather.

“I was very surprised!” she says of winning this month’s EOM. “I’m very appreciative and excited about my parking spot!!”

Employee of the Month for June 2014: Krista!

As a Doctor’s Assistant on the Client Care Team, every day for Krista is filled to the max! “rooming patients, putting together estimates and invoices, dispensing medications, answering questions and client concerns, setting up appointments and scheduling surgeries, AND whatever else my doctor needs!” are just some of the tasks she does day in and day out since joining our team in July of 2011.

Nearly 2 years ago when Krista joined us, she says that Allison recruited her, “and I wanted to broaden my experiences in the veterinary field”. She attributes her success here to her “very supportive team” and “team leaders are very encouraging and help whenever needed.”

Although public speaking is hard for her she admits, she appreciates the ability to “learn something new every day” which she says is her favorite part of the job.

“I was surprised!” says Krista about her employee of the month for June. “My efforts don’t go unnoticed and I feel like my contributions are actually appreciated … Everything I have been through recently, everyone here is so helpful, everyone just wants me back to 100%.

Hanging out with friends, family; concerts and baseball games are a few of her favorite things to do when she isn’t here but lately she’s been building and fixing her fence that BB, her dog, continues to break through. “It’s so frustrating!”

Although she has only seen the movie once, she says the Snowman song from Frozen is the catchiest tune around right now that she can’t help but sing along too.

Given the opportunity to host a dinner party she immediately says she would invite Usher, along with Jay Sean and her grandfather who has passed away – “it would be very interesting!” she says with her classic laugh.

Employee of the Month: May 2014

Danielle Quintero, RVT
Patient Care Team

Over 6 years ago, Danielle (aka DQ)walked into Encina Veterinary Hospital and became a crucial part of our team. Her role as a Registered Veterinary Technician plays such an important part in our hospital – both to patients and to collegues.

Each day, DQ tends to our emergency patients as well as those in-patients who need around the clock care in our ICU unit. Inbetween ICU patients and emergency patients, DQ monitors anesthesia and vitals of our patients in surgery.

DQ decided to join the team at Encina 6 years ago for some very practical reasons: close to home, featured emergency and critical veterinary care and of course, we were hiring! She continues to stay and grow with us because she likes the “fast paced, multi tasking team based environment, the way we manage cases and the high quality veterinary medicine we provide.”

She admits the job isn’t always easy, as she can’t “save them all,” but she says her strong work ethic keeps her focused and successful. “I was honored, very shocked,” says DQ when she was told that she had won our Employee of the Month for May.

When DQ is not here at the hospital, she stays busy thanks to her 3 year old son AJ and trips to Monterey Bay’s beach. At home, you can catch her gardening (she’s got some roses she is particularly proud of), home improvement projects and Netflixing her new guilty pleasure Revenge.

DQ says the song that will never fail to make her sing along to is Gloria Gaynor’s, I Will Survive. Should she have a dinner party with 3 people dead or alive, her picks are: her father, Etta James and Chuck Berry – a party focused on her love for music.

Welcome Dr. Liz Milauskas!

We are very excited to announce the return of Dr. Liz Milauskas to Encina Veterinary Hospital as she will join our team of doctors as a full-time general practitioner starting NOW!

Dr. Milauskas was raised in southern California. Unsurprisingly to her friends and family, Dr. Milauskas pursued a career as a veterinarian after completing her undergraduate degree in Biological Sciences in 1994 from UC Davis. Following graduation, she moved to Dublin, Ireland where she attended veterinary school at University College, Dublin Ireland Upon graduating with a degree in veterinary medicine in 2000 she returned to the United States and began practicing veterinary medicine in Oregon for the next 8 years.

In 2008 to 2009, Dr. Milauskas returned to California and completed an internship at Encina Veterinary Hospital. In addition to completing the internship, Dr. Milauskas studied alternative therapies, such as acupuncture, and has integrated them with traditional veterinary medicine. Since completing a veterinarian acupuncture course at Colorado State University she has become a certified veterinary acupuncturist.

Dr. Milauskas is also certified in Penn Hip, which is a multi-faceted radiographic screening method for canine hip evaluation. This is the ideal way to radiographically evaluate canine hips for dysplasia and there are only a small percentage of veterinarians that are certified to perform this diagnostic test.

Dr. Milauskas is a member of the American Veterinary Medical Association, the California Veterinary Medical Association, the Oregon Veterinary Medical Association, and the International Veterinary Acupuncture Society.

On her days away from veterinary medicine she enjoys running, hiking, traveling, and spending time with her husband, their two Labradors (Kiely and Lily) and their French Bulldog (Max).

Importance of Annual Exams for Dogs and Cats

Annual exams are important part of veterinary medicine, in part due to the fact that they provide a veterinarian with incite into how your pet has been doing since its last visit, they address and treat certain problems or conditions that may be going on with your pet presently, and they can provide your animal with preventative measures such as vaccinations and medications that are important factors at preventing the spread of diseases not only to your animal, but also to prevent the spread of disease to other animals that your animal may come in contact with — including yourself.

During the annual exam, a veterinarian will ask certain questions about your pet’s history in order to see how your pet has been doing since its last visit. Some questions may be geared toward problems that have been going on, while some other questions may be directed toward finding out the answer to a specific problem(s) that may have been occurring recently or in the past. By asking these questions, it allows a veterinarian to gain knowledge about an animal’s overall health and about the management of certain diseases or problems that an animal may have. It also allows the owner to ask questions to a veterinarian about concerns or problems that they may with their pets at home over the past year.

After the history of a pet has been taken and the owner’s questions have been answered, a veterinarian will perform a physical examination in order to help determine the current health of an animal. A good physical examination will take a look at different parts of your animal’s body to determine if any disease is present. For example, a veterinarian may listen to the heart to determine if there is evidence of any heart disease and he or she may palpate the animal’s belly in order to determine if any abnormalities are present within the internal organs. There are many organ systems that can have disease present and that the owner may not be aware of these problems being present until a complete and through all physical examination is performed by a veterinarian. This is one of the reasons why annual exams are extremely important to have performed consistently, so that problems associated with certain organ system can be caught early and be addressed through diagnostics and/or treatment.

In addition to the physical examination, a veterinarian may ask an owner to have annual blood work and urinalysis performed in order to screen for certain diseases. Blood work and urine screening allow the veterinarian to look at how certain organ systems are functioning on a physiological manner and to see if any changes in the blood work or urine could indicate disease. Animals can appear overtly healthy on the outside, but physiologically they can have disease present. This is why it is important and recommended by veterinarians to have these tests performed on a yearly basis.


After the physical exam and diagnostic tests have been performed, preventative measures such as flea/tick control, teeth brushing/cleaning, hair coat maintenance, and/or vaccinations can be discussed by a veterinarian. These preventative measures are extremely important in veterinary medicine because they help to prevent the spread of disease not only in the animal they are examining, but also help to prevent the spread of diseases to the community of animals or humans that the animal lives in. Without these preventative measures in place, more diseases would be prevalent than they are today. This is why it is important to vaccinate pets yearly and to use preventative medications monthly in order to help control the spread of infectious diseases within a community.

Therefore, in order to ensure the health of our pets and of the community with which they live in, annual exams should be performed to not only to prevent the spread of diseases through vaccinations and medications, but also to evaluate, address, and treat certain diseases that could be present within our pets. Early screening for any disease can help to monitor an animal’s overall health and if a disease is caught early, it can decrease the impact that it may have on animal’s future lifespan.
If you have not gotten your pet’s annual exam performed this year, please schedule an appointment to have them looked at to ensure that they are feeling at their best, to screen them for any diseases, and to ensure that they can be protected against diseases that they may come in contact with in the future.

Jonathan MacStay, DVM

A Day In the Life of an Intern at Encina Veterinary Hospital

Each year, Encina Veteirnary Hospital welcomes about 6 newly graduated doctors of veterinary medicine for a 1 year rotating internship with our specialists where interns gain more clinical experience and see quite the diverse palate of cases which will help with his or her career down the road.

At Encina Veterinary Hospital in Walnut Creek, an intern typically starts his or her day by waking up early in the morning for a very busy and productive day at work. The morning of the work day begins with daily rounds at about 7:00am regarding the cases that are currently in the hospital with the overnight, attending emergency clinician and the internal medicine specialists. After the daily morning hospital rounds, some mornings are filled with topic rounds given by the various specialist and general practitioners. These topics can range from general veterinary medicine to emergency medicine to specialized topics. The interns are challenged during these topic rounds to answer questions about the subject in order to ensure they understand important points about the covered topic.

After topic rounds or after morning cases rounds, the interns then work for the remainder of the daytime with their designated veterinary specialist to observe the daily appointments, go over the history and physical examination findings for each case, review the most common differentials for each of the cases, review how these cases are treated, and discuss the relative outcome of these cases. During part of the daytime, some of the interns may be challenged to see emergencies that might walk through the door, they may have to help the specialist with various procedures like endoscopy or surgery, or they may have their own surgeries to perform on certain designated cases.

At the end of the day when all the appointments have been seen and all the pets have been treated or cared for, the interns are responsible for helping senior doctors write up some of the medical records for the patients seen today, review and ask questions about the cases with their attending clinician, and help to round the cases that are transferring over to the overnight emergency doctor.

After nearly 12 hours of hard work, it’s about time for an intern to start heading home for the night, rest up and repeat the next day. This is a typical day in the life of a veterinary intern but day-by-day, there are always new changes to the daily schedule that could always challenge an intern to change his or her thinking or be presented with new cases that could challenge the way they learn. This is the life of a veterinary intern.

Jonathan MacStay, DVM