How Can I get my pet to like going to the Vet?

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Our veterinary team agrees that we did not enter into this field of work to terrify pets. Having that happy dog bounce into the clinic or the cat that allows snuggles makes our day worthwhile. Unfortunately, pets can’t understand how visiting the vet can help them. They just know it smells scary, has lots of stressful noises and usually something uncomfortable happens, like the prick of a needle for vaccines. We know that pets feel fear the same way we do, and it can be extremely hard for owners to see their beloved pet feel this way. Owners may avoid bringing their pets into the clinic unless they absolutely need to - It can be very challenging for us to help your pets stay healthy if we don't see them.  "An ounce of prevention is worth a pound of cure" truly applies to animal health care.  Awareness is the key to alleviating fear, anxiety, and stress for our patients. Signs of stress can be subtle so this can be tricky. In dogs, signs of fear can be as simple as licking lips, avoiding eye contact or panting.  In cats, stress signs include tail held closer to the body, whiskers slightly back and ears partially to the side. We use all these subtle cues to guide us in our handling and approach for procedures. We need to be aware of when and why our patients get stressed. Dogs tend to feel most stress from noise and experience the most fear before coming into the clinic or in the waiting room. Cats are similar but they feel the most stress from a change of environment, leaving their house and entering the exam room and being put on the exam table. Most cats are told at home that jumping on tables is bad and now we are putting them on a strange, cold table. All this leads to patients leaving “fear” pheromones that are then detected by incoming patients. 

Keeping this in mind we have made some simple changes so that we can create a lower stress experience for our patients, which we know will make for a happier visit the next time. We try to ensure that all our patients go directly into their own exam room and not wait in the waiting room in order to minimize noise. There is a cat only exam room so that our felines do not suffer from the dog smell, which can be quite offensive to them. We use diffusers in our waiting room and exam rooms, as well as sprays applied to towels and bandanas, to replace fear pheromones with comforting dog and cat pheromones that humans cannot smell.  There is wide array of high value treats used to distract your pet during any procedures and help to create a positive association when our patients come to see us. We want to be known as the “treat people” not the “mean people”. Our cupboards are full of liver treats, biscuits, peanut butter, kong fillers for dogs and a wide array of flavoured treats and cat nip for cats. Because our patients are less likely to want treats when nervous, we highly recommend they are not fed right before coming to the clinic. Those treats then look very appealing to an empty tummy. If possible, we avoid putting patients on tables because having their feet leave the floor is stressful. If feet do need to leave the floor, we lift in a way that gives them a sense of security. Cold, slippery tables are covered by a non-slip warm blanket.  A corner stone to preventing stress for our patients is our pre appointment relaxation medication. We use a combination of medications that we will dispense before our patients come to the clinic. They are not meant to drug and sedate, but to reduce anxiety and fear from ramping up when our patients see those cues that signal that they are going to the vet - Maybe it’s the carrier or the particular route in the car. Once they come through our door, things seem less scary because that anxiety has not been mounting. We can get through procedures such as trimming nails or collecting a blood sample using minimal restraint. If we need to deviate from our low stress handling because a patient is becoming too resistant, we will stop. Pushing through and using force is unfair to our patients and will only increase the fear for the next visit. Our priority is patient care, and we know creating a fear free environment is integral to a happy relationship with our patients.  

We see a surprising number of ear infections in veterinary medicine, as compared to human medicine.  There are multiple contributing factors that result in this increased frequency in dogs and cats.  The shape of the ear canal in our pets is like a “J”, being compromised of a vertical and horizontal ear canal.  Humans have a straight ear canal, allowing for better air flow and easier expulsion of waxy debris.  As a result, dogs and cats are more predisposed to a build up of wax and debris along their canals.  In addition, anything that facilitates excessive wax and debris deposition will predispose to infection, whether that be anatomically narrow canals or irritation caused by water in the canal from a bath or swim.   The most common underlying cause for ongoing or recurrent ear infections in our pets is uncontrolled allergic skin disease, resulting from food and environmental allergies.  The allergic reaction in the skin to any number of factors will result in inflammation, heat and moisture.  The ear canal has now become an exceptional environmental for the overgrowth of bacteria and yeast that live there normally at low numbers.  The overgrowth of these organisms will cause further inflammation, swelling along the canal, pain, and itchiness.  Your pet may be too painful to allow you to examine or clean their infected ears at home. 

When your pet comes to see us with concerns about an ear infection, we will attempt to examine the length of their external ear canal with an otoscope to determine if they have debris present, masses/polyps evident and an intact ear drum.  Occasionally, pets may be too painful to allow a full evaluation of their canal, therefore, we can attempt to repeat this at their recheck appointment.  We will gently obtain ear swabs from deep in the ear canals to allow cytologic evaluation under the microscope, in order to determine which type of organisms are present and the best medication to address the infection. We will later compare back to the original ear swabs results when evaluating if our treatment plan is working. We cannot skip this important step and just dispense ear medication.  If your pet is comfortable enough, we will thoroughly clean the ear canals to facilitate treatment at home with the prescribed ear medication.  We will review treatment options, application of your pet’s ear medication and home ear cleanings. It may be possible to use a longer acting ear medication that does not require daily dosing, which can be helpful for busy schedules or patients that will not tolerate manipulation of their ears. We feel it is important to ensure complete resolution of your pet’s infection before we stop treatment, therefore, we recommend that all pets suffering from ear infections return to the clinic after the recommended treatment length for recheck ear swabs. Your pet’s ears may look like they have returned to normal when mild infection is still present.  If we stop treatment too soon, it will appear that they have another ear infection, however, it may be the same unresolved infection. A resistant infection can develop if we use ear medication for short durations. This commonly happens because we have some ear medication left over and are tempted to use when our dog starts scratching at their ears again. Who wants to take another trip into the vet? With short ineffective treatments, we kill the most sensitive bacteria and leave only the resistant ones to grow. We may reach a point where it is difficult to find an ear medication that will clear the infection.  If you pet has developed ear infections in the past, we will discuss possible underlying causes with you during their initial appointment.  Our goal is to help you make the best decisions for their care moving forward in order to eliminate or significantly decrease the frequency of their ear infections.  

Cats are complicated creatures, and their behaviours could not be more different compared to dogs. Dogs work very hard to communicate their emotions to us. Cats, on the other hand, have a strong instinct to hide any illness, making our jobs of caring for them more challenging. 

When it comes to osteoarthritis in cats, we know that cats as young as 2 years old can develop joint disease. 60% of cats over 6 years of age and 90% of cats over 12 years of age have signs of arthritis on radiographs but unfortunately only 13% of these cats are recognized. This highlights how many of our cats suffer in silence with chronic pain. There are risk factors to developing osteoarthritis such as outdoor cats, history of trauma, congenital abnormalities, and some breeds such as Scottish fold, Maine coon and Ragdoll have increased risk.

Our job as veterinarians is not only to extend quantity of life but to improve quality. This means we need to identify arthritis in our patients, however, we rely on observations from our pet owners at home because, in the hospital, our cat patients hunker down in their carrier or slink under a chair. During an orthopedic exam, cats can understandably become quite hostile to our manipulations if we are dealing with sore joints, again making it near impossible to establish sources of pain. What are the signs of arthritis at home? Chances are you won’t appreciate your cat limping - Instead there will be subtle signs of reduced agility and behavioral changes. Using a Osteoarthritis Checklist , which includes short video clips showing changes in movement of arthritic cats and general behaviour changes, can provide invaluable information to us. There are questions that we will ask you during an examination that can help uncover the presence of arthritis.

Have there been any changes in your cat’s ability or wiliness to:

• Jump onto elevated surfaces or needing to use a lower piece of furniture to jump up
• Play with you or needing to lay down more during play
• Using their scratching post

Have you noticed:

• A stiff walk or hunched back
• A limp
• Vocalizing or hissing when stroking over a joint or moving your cat

Have you seen any of these changes in your cat’s behavior?

• An increased grumpiness with you or other animals in the house
• Changes in petting tolerance
• More withdrawn and less willing to interact or more clingy
• Being less active or sleeping more
• Sleeping in unusual locations (under bed or on the floor)
• Reluctance to go upstairs or going up stairs more slowly
• Purring less
• Reduced appetite
• Changes in hair coat (areas of matting and dandruff) or overgrooming certain areas

When considering vaccinations for your cat, it’s may seem obvious that outdoor cats will have a higher risk of exposure to infectious diseases and will need additional protection. Many cat owners, however, may wonder why they need to give vaccines to their indoor cat. Here are some good reasons why you want to ensure your indoor cat is protected: 

1. You may bring home a kitty addition to your cat family.   Let’s be honest, these are not always planned! 
2. Your outdoor cat may escape to the outdoors 
3. You may decide down the road that your indoor cat will become an indoor/outdoor cat. 
4. Viruses, such as Feline panleukopenia, can be transmitted on fomites (clothing, shoes, hands) 
5. A wild animal, such as a racoon or bat, may get in your house causing concern for Rabies exposure 

Rabies vaccination for our pets is required by law for good reason.  Although rabies is rare, it is zoonotic (can be transmitted to people).  Infection is always fatal in unvaccinated animals and may be fatal in humans. Vaccination for our pets is a very effective and easy way to prevent many diseases, including rabies. 

We understand that our clients need to weigh the risks and benefits when choosing vaccinations. Potential concerns following vaccination include a slight fever, lethargy, anorexia, soreness at injection site and,  very rarely, an allergic vaccine reaction or vaccine site associated tumors.  Adjuvants, contained in many vaccines are used to enhance the body’s immune response but can, unfortunately, cause some of these negative side effects. Our vaccines are free of adjuvants and are a smaller volume, which our cat patients appreciate. We always review lifestyle with our clients to decide which vaccines will be required to keep their cat safe. Let’s look at the infectious diseases we recommend all our patients are protected against in their core vaccines, Feline Viral Rhinotracheitis, Calicivirus, Panleukopenia (FVRCP) and Rabies:

• Feline Rhinotracheitis Virus: a virus that affects the upper respiratory tract and is transmitted by oral, nasal, and ocular secretions. Young cats most often affected but cat of any age is at risk. Signs include sneezing, coughing, anorexia, and nasal/eye discharge. 
• Feline Calicivirus: a virus that is highly contagious and affects the upper respiratory tract and is transmitted by oral, nasal and ocular secretions. Young and old cats are more likely to experience severe symptoms. Infection of pregnant cats can cause abortion. Signs include sneezing, congestion, fever, anorexia and drooling from oral lesions (ulcers). There are more virulent strains that may cause death.  
• Feline Panleukopenia Virus: a virus that infects non-domesticated cat family, raccoons, and members of the weasel family. It is highly infectious and typically seen in kittens and young cats. It causes vomiting, diarrhea, fever, depression, and lethargy. Infection can be fatal.  
• Rabies Virus: a virus that is transmitted by a bite from an infected animal such as racoons, skunks, foxes, and bats. It affects the brain and central nervous system. Signs include fever, seizures, paralysis, change in behaviour, in coordination and salivation. Rabies is always fatal in an unvaccinated animal and is zoonotic to humans. If an unvaccinated animal is exposed to a potentially rabid animal, they must be quarantined to watch for symptoms. There is no test for rabies.  

An optional non-core vaccination for indoor/outdoor cats is Feline Leukemia Virus. This virus is shed in the urine, feces, and milk of infected cats. It can be transmitted during grooming, sharing bowls, bite wounds and during pregnancy. In the early stage of infection there usually is very few clinical signs but, over time, the virus affects the immune system and can cause cancers and blood disorders.  Signs can be vague and wax and wane.  

The vaccine appointment has another invaluable aspect that we can’t over emphasize - the physical check up. A study was done that surveyed pet owners and found that, even though there are 25 percent more cats owned compared to dogs, only 40 percent of the appointments at veterinary clinic are for cats (World of Feline Resistance). This highlights that cats are generally not seen by a veterinarian until they are quite sick. Cats are experts at hiding signs of illnesses - Our doctors ask very specific questions and complete a thorough physical exam to detect issues that an owner may not be aware of.  For example, baldness of the belly caused by excessive licking may be associated with bladder discomfort and affected pets may be at risk of an emergency urinary blockage.   Cat owners may not know that their pet has a painful broken tooth, which is at risk of developing an abscess.   Many cat owners report that their pet is frequently trying to bring up a hair ball and may mistake this as a normal feline issue, however, the behavior may actually be a cough commonly seen with feline asthma. Regardless the choice surrounding vaccines, a regular check up is vital to the health of your cat.   

When we discuss vaccinations for your dog, we often need to consider your pets lifestyle in order to make recommendations that will keep your pet protected.  We will discuss with you factors such as:

1. Exposure to other dogs
2. Access to wildlife and their environment
3. Local and international travel
4. Exposure to ticks 

We understand that our clients need to weigh the risks and benefits when choosing vaccinations. Potential concerns following vaccination include a slight fever, lethargy, anorexia, soreness at injection site and,  very rarely, an allergic vaccine reaction.  Adjuvants, contained in many vaccines are used to enhance the body’s immune response but can, unfortunately, cause some of these negative side effects. Our vaccines are free of adjuvants and are a smaller volume, which most pets appreciate.  Let’s look at the infectious diseases we recommend all our patients are protected against in their core vaccines, Distemper Virus, Parvovirus, Parainfluenza virus, Adenovirus (DA2PP) and Rabies:

Canine Distemper Virus: a virus that affects the respiratory tract, gastrointestinal tract and the central nervous system.  It is transmitted by oral, nasal, and ocular secretions. Young dogs most often affected but unvaccinated dogs of any age are at risk. Signs include fever, coughing, vomiting/diarrhea and seizures.  This infection is often fatal.  

Canine Parvovirus: a virus that is highly contagious and affects the gastrointestinal tract and bone marrow.  It is transmitted by fecal-oral transmission and sustains very well in the environment, resulting in infection of entire litters. Signs include fever, vomiting, diarrhea, and anorexia.  There is a fairly high fatality rate in young puppies that contact this virus and survival is often associated with intense care for days to weeks in hospital.  

Canine Parainfluenza Virus: a virus that is highly contagious and affects the upper respiratory tract.  Affected dogs typically experience coughing, nasal discharge, fever and lethargy.  Infection can progress to pneumonia.  

Canine Adenovirus:  a virus that affects the respiratory tract, gastrointestinal tract and liver.  Signs of this infection include dry cough, retching/gagging, fever, lethargy and nasal discharge.  This virus is typically transmitted in urine, ocular and nasal secretions from infected animals.  In severe cases, more common in puppies, this infection can be fatal.

Rabies Virus: a virus that is transmitted by a bite from an infected animal such as racoons, skunks, foxes, and bats. It affects the brain and central nervous system. Signs include fever, seizures, paralysis, change in behaviour, in coordination and salivation. If an unvaccinated animal is exposed to a potentially rabid animal, they must be quarantined to watch for symptoms. There is no test for rabies.  Rabies vaccination for our pets is required by law for good reason.  Although rabies is rare, it is zoonotic (can be transmitted to people).  Infection is always fatal in unvaccinated animals and may be fatal in humans. 

Optional (non-core) vaccinations are also available for dogs, depending on lifestyle risks.  These include Bordetella, Leptospirosis, and Lyme:

Bordetella Bronchiseptica:    a bacteria transmitted in respiratory secretions of infected dogs and through fomites (surfaces) where infected dogs have been.  This bacteria will typically cause a dry hacking cough but can progress to life threatening pneumonia in some cases.   This vaccination is typically recommended for dogs that will be exposed to unknown dogs or frequenting facilities with high dog traffic (dog parks, boarding facilities, grooming facilities and puppy classes.  

Leptospirosis:  a bacteria transmitted in urine of infected wildlife/dogs, targeting the kidneys and liver.  Initially, this infection will cause fever, lethargic, decreased appetite and possibly increased drinking and urination.  For pets that are treated aggressively and recover, many will have permanent organ damage.  This vaccination is recommended for dogs that have any risk of exposure to wildlife and their environment.

Lyme disease:  caused by the bacteria Borrelia burgdorferi, transmitted by deer tick bites.  Although dogs can be protected with oral or topical tick preventative products, this vaccine is recommended for pets that have a high risk of exposure to ticks (camping, cottaging, living in tick endemic regions).  Lyme disease can result in damage to the kidneys and the joints of affected dogs.

The vaccine appointment has another invaluable aspect that we can’t over emphasize - the physical check up. We want to help keep your pet healthy and happy for as long as possible - Our doctors ask very specific questions and complete a thorough physical exam to detect issues that an owner may not be aware of.  For example, subtle changes in mobility and range of motion can indicate early arthritic change.  Behavioral changes, such as sleeping more and being less playful, may be mistaken by owners as normal aging change when, in fact, their pet is experiencing pain.  Regardless of the choice surrounding vaccines, a regular check up is vital to the health of your dog.   

Many bunny owners have experienced a time when their bunny was not eating well, scratching at an ear, sneezing, or had a strange scaling patch of skin and required a trip to their veterinarian. But just like with cats and dogs, regular health exams are vital to the prevention of many illnesses in rabbits. 

Let’s look at what’s involved in a rabbit checkup and why it’s so important:

1. All our health exams start with an extensive history that dives into many aspects of rabbit husbandry and nutrition. These little guys may seem simple to care for but many of their illnesses are preventable. Diet is probably the single most important factor in maintaining their health. Rabbits are adapted, in terms of their teeth and digestive tract, to eating a diet high in fiber, low in fat and low in starchy carbohydrates. Bunnies love their food but if they are fed the wrong things, serious digestive problems develop. Cage flooring and bedding, mostly in term of ease of cleaning, can predispose to foot infections (pododermatitis) and respiratory infections.
2. We track weight to monitor for any concerning changes which may indicate a chronic health condition. Weight loss may be the first indicator of dental or organ disease. Obesity, which is common in pet rabbits, can place strain on arthritic joints and predispose to pododermatitis
3. We do a full head to toe exam. Rabbits, especially floppy eared breeds, are prone to ear infections that we may not be able to detect unless we look down the canal with an otoscope. It’s important to evaluate their teeth to look for elongated molars, spurs, and signs of infection or excessive salvation that could indicate oral pain. Rabbit’s molars are actually very small and so we use a special tool with a magnifying camera to assess them. 
4. We discuss any behavioural concerns such as aggression, poor litter box habits, changes in activity level and difficulties with bonding to other rabbits. 
5. We can perform wellness blood work to evaluate organ function and detect diseases in the early stages. It’s also gives us a baseline to refer to during periods of illness. 
6. We finish off our exam with a lovely and relaxing pedicure (aka nail trim)

The most common reason for bunny visits to our hospital is a decline in appetite. After a thorough history and physical exam, gastric stasis is typically identified. Gastric stasis is not a diagnosis and is secondary to something such as stress, pain, or organ disease but it can be tricky to identify what the actual reason behind the appetite change is. Intestinal obstruction can at first appear to be gastric stasis, and even though both are dangerous, intestinal obstruction can cause death very quickly. Because rabbits are prey animals, they will appear stoic when sick or stressed, making it hard to evaluate how sick they really are. 

Let’s look at intestinal obstruction first and then review all the possible causes of gastric stasis. Rabbits groom regularly and will ingest a large amount of hair daily. Years ago, whenever we examined a rabbit with gastric stasis, we would identify a large amount of hair in the stomach and thought this was the cause of their signs. The presence of this hair is secondary to the slowing down of the digestive tract and not actually the problem, but hair balls can become impacted within the small intestines as the diameter decreases in size which is a problem. Furthermore, rabbits love to chew things like bedding and carpet that can also cause an impaction. A rabbit can stop eating and experience a decrease in bowel movements with either gastrointestinal stasis or with an intestinal obstruction however, they will appear much sicker with an obstruction. It’s important that bunny owners not force feeding for an extended period if their bunny stops eating and appears lethargic. The additional food to an obstructed digestive tract can cause death. 

On physical exam, these rabbits are usually very depressed, have abdominal pain and will be hypothermic. When we assess blood work, they will usually have a very high blood sugar. Lastly, abdominal x-rays will show a distended, fluid and gas filled stomach. We may also see large, gas distended intestines. Treatment needs to be aggressive and includes pain management, intravenous fluids, and close monitoring in the hospital. The hope is that the impaction will pass but surgery may be required and carries a high risk. 

The most common reasons we see gastric stasis in a rabbit include poor nutrition, stressful events, and dental disease. Rabbits require a diet high in fiber, low in fat and low in starchy carbohydrates. Grasses or hay provide a balanced source of protein, digestible and indigestible fibers, vitamins, and minerals. Fiber stimulates the digestive tract and helps to wear down their teeth which is continually growing. This should be the bulk of a rabbit’s diet, but unfortunately it can be difficult to persuade a rabbit to eat a new food item once they become accustomed to a particular diet, which highlights why it is so important to start with good nutrition habits from a young age. A bunny with bad nutrition habits will be prone to repeated bouts of gastric stasis. 

Treatment of gastric stasis consists of first trying to identify the underlying cause which can sometimes remain a mystery. If the bunny appears stable and we are confident that there is not an obstruction, we give fluids to address any dehydration and send home with pain control and a high fiber, nutritious supplement called Critical Care that is feed 3-4 times daily. We can also use a medication that hopefully will stimulate movement of the intestinal tract. Owners can encourage some exercise or rub their bellies to get things moving. Typically, improvement is seen in 1-2 days, but owners need to watch closely. If their bunny becomes more lethargic, bowel movements decrease further or they seem more painful which is seen as a hunched posture, grinding of teeth and increase in breathing rate, this is an emergency, and they need to be seen by a veterinarian immediately. Once a bunny allows us to see they are visibly sick, they are critical.

Because inadequate nutrition is a common cause of gastric stasis, let’s review what a bunny should eat. Good nutrition should consist mostly of hay or grasses. Some bunnies like courser hay while others may prefer softer grasses, and ideally it needs to be fresh. Hay from the pet store can sometimes be old by the time it’s purchased which can be a factor in hay refusal. Hay should be placed near where a bunny spends most of their time which is typically their litter box. To entice ingestion of hay, items can be mixed into hay such as some greens or spritzed with fruit juices. Pellets should be timothy based with no seeds or cereals. They may look boring to us, but bunnies love their pellets so don’t be surprised when they pounce on them before you can even set them down. We need to be careful they don’t over do it and then have no room for their hay. An average 5 lb bunny should receive ¼ cup twice daily. If a bunny owner is feeding more then the ideal amount, they should slowly decrease the amount over weeks. Greens should be introduced one at a time to ensure there is no stomach upset and up to 2 cups daily can be given. Last is the sweets; sugary foods such as carrots and fruit should be given in very small amounts a few times weekly. When deciding on portion size, consider the size of the bunny. If a bunny is given a full carrot which is half the size of them, that is like us eating a pie half the size of our arm span. Who wouldn’t get stomach upset eating all that pie!

Treating a patient that cannot tell you where it hurts is one of the toughest aspects of being a veterinarian. Animals feel pain just like us and so we understand that chronic pain impacts them physically and emotionally. Osteoarthritis is the most common cause of chronic pain in dogs, but the signs can be subtle and may be mistakenly attributed to the normal aging process. The first step is recognizing what pain looks like - a simple pain checklist like the one below can help:  https://www.zoetispetcare.com/checklist/osteoarthritis-checklist 

We want to assist you in ensuring that your pet has their best quality of life by using a combination of pain management, nutrition, lifestyle modification and rehabilitation as soon as signs of progressive joint disease are exhibited: 

Pain Management 

There are many factors involved in the pain pathway and perception of pain. A multimodal approach is required to target the peripheral and central nervous system 

Non-steroidal Anti-inflammatories (NSAIDs) alleviate pain by treating the inflammation associated with damaged tissue.  In other words, they target the peripheral nervous system. NSAIDs currently remain the first line in pain management for orthopedic discomfort, based on the high level of evidence for their efficacy. We currently have a variety of NSAIDs approved for use in dogs and choosing the most effective one is very individual for each patient. A positive response to the drug should be seen within 2 weeks, therefore if no improvement is seen, it may be worth trying a different NSAID before considering adding another pain medication. Daily administration is recommended because studies have found there is a cumulative therapeutic effect. In some patients it is possible to wean down to the lowest effective dose or use as needed, however, if a setback in symptoms is seen, full daily dosing should be reinstated. Adverse events with NSAID use are uncommon, especially when we consider the number of patients using these medications. Potential adverse events include gastrointestinal ulceration, kidney toxicity and idiosyncratic liver damage that is typically seen within 2-4 weeks of starting an NSAID. We can minimize adverse effects by avoiding use in patients with known kidney and/or liver disease and by performing monitoring bloodwork to regularly assess kidney and liver health. 

Gabapentin blocks channels on nerves in the central nervous system which decreases the transmission of pain signals up to the brain. Once pain reaches the spinal cord, it can be difficult to control - The nerves that previously transmitted pain can become the source of pain (neuropathic pain). Gabapentin can be an adjunct to pain management by decreasing pain in the spinal cord. Adverse effects are minimal and include sedation and incoordination. These can be avoided with a gradual dose increase. In some patients, sedation at night can be helpful to achieve much needed rest.  

Amantadine inhibits receptors in the spinal cord that cause maladaptive changes to nerves due to repeated signals of pain from the peripheral nerves (central sensitization). This lowers the pain thresholds, meaning pain that was previously perceived as mild, now feels amplified. Amantadine is an adjunct to pain management just like Gabapentin. Adverse effects include stomach upset and it should be used with caution in patients with kidney disease and seizures.  

Tramadol is metabolized into many metabolites that affect the same receptors as opioids (ie: morphine) but has a weaker effect and variable pain control. Repeated dosing may result in reduced effect but for some individuals it can be used as an adjunct pain medication. Adverse effects include sedation, stomach upset and should be used with caution in patients with severe kidney and liver disease and seizures.  

Cartrophen (pentosan polysulfate sodium) is a sulfated sugar of plant origin that has been shown to stimulate cartilage production, improve joint fluid quality and decrease inflammation within the joint. It is an injectable given under the skin once weekly for four weeks and then at an interval that controls symptoms, typically monthly. It can be administered in the hospital or at home by pet owners.  

Cannibis products (CBD and THC) has been shown to alleviate orthopedic pain in humans.  The prospect of its use for pain control in our furry friends is promising and has emerged as a promising field of research.  At this time, there are no cannabinoid containing products available for veterinary use in Canada (this does not include hemp products).  Veterinarians can not legally prescribe cannabinoid products for your pet, we can provide guidelines that ensure safe use if a client elects to pursue this.  

Nutrition 

As the incidence of obesity rises in our pets, we need to recognize obesity as a disease that dramatically affects quality and duration of life. Carrying a few extra pounds places strain on joints and causes fat cells to produce harmful chemicals that damage even non-weight bearing joints. There have been many studies that have shown weight loss alone can reduce symptoms of osteoarthritis - In some cases, the effect of weight loss is equivalent to the use of anti-inflammatory medications on weight bearing. For breeds prone to joint disease such as hip dysplasia, obesity can significantly reduce the age of onset for osteoarthritis. Because weight management is so important, we work with our clients to find the right food to suit budget and lifestyle, while maintaining optimal nutrition. Our skilled senior registered veterinary technician, Stacy, can provide customized nutritional counselling for your pet and ongoing support to our clients.  A good weight loss plan should include: 

Appropriate caloric intake for weight loss - We need to explore calorie consumption in a typical day, and let’s be honest, it needs to include ALL treats. We need to be very precise with our daily amount - even just a few extra kibbles can add up quickly. If the current diet being fed is calorie dense, the volume fed to achieve weight loss may be too small, resulting in hunger and inadequate nutrition. Therapeutic weight loss diets have many advantages - They are low in calories, help to encourage muscle mass, increasing metabolism and help pets to feel full.  

Accountability - There is a reason why programs like Weight Watchers’ work. Weight loss is hard, sometimes we go off track or become frustrated by not seeing immediate results and we need someone supporting us. We have regular pet weight updates to support our clients and adjust the plan if things aren’t progressing as we would expect.  

Sustainability - Yo-yo dieting for pets is a real thing. We must ensure that our patients don’t fall off the wagon once they have reached their weight loss goal.  We teach our clients how to assess body condition score and closely monitor weight at home. In theory, calories can be increased to maintenance level but some of our patients need to stay on a weight loss diet indefinitely.   

Dietary supplements containing glucosamine, chondroitin, and omega 3 fatty acids can help with joint health, decrease inflammation associated with arthritis and reduce the amount of NSAIDs needed.  With many joint health products, it will take up to 2 months to appreciate improvement, therefore, we recommend these products long term. Given the large selection of products, it can be difficult knowing which are safe and effective. Supplements are not necessarily subjected to quality control and may not contain the ingredients or concentrations listed on the label. When choosing a product look for a more established company, a third-party verification of quality and safety, and studies showing efficacy. Prescription joint diets have the advantage of containing many of these joint health additives, as well as therapeutic levels of the omega 3 fatty acids (EPA and DHA) with studies to support the benefit to arthritic patients. If supplementing with omega 3s alone, the most potent source of EPA and DHA is fish oil which needs to be protected from light. Flaxseed, linseed or canola oil is not a good source for dogs. Human brands such as Nordic Natural and Weber products can be used but be sure to avoid products containing Vitamin D and other flavourings.  

Lifestyle Modification 

Regular exercise and activity modification is essential in minimizing weight gain, joint stiffness, muscle loss and decline of function. An ideal exercise program for dogs with osteoarthritis is regular, low impact exercise that is controlled. More benefits are seen with smaller doses of daily exercises rather than long irregular sessions. Low impact exercises such as swimming, will reduce the force on arthritis joints. High acceleration exercises such as running or jumping amplifies the impact on joints and should be avoided. Controlled exercises such as leash walks allows an owner to be the voice of reason and avoid activity that their pet may pay for the next day.  Home environment modification refers to configuring a home to accommodate a dog with osteoarthritis. Traction when standing up can be provided by non-slip booties or non-slip runners, especially directly under/around dog beds. Stairs can help provide active range of motion, improve strengthening and foot placement but they need to be non-slip. Going downstairs places a lot of force on front limbs and gravity makes a slow decent difficult so assistance using a sling or harness may be needed. Bedding should be supportive and placed in a warm area. Pulsed electromagnetic field beds such as the Loop Lounge from https://assisianimalhealth.com/pet-owners/ can provide non-pharmaceutical pain relief. Nails should be kept short to prevent slipping and arthritis developing in toes. Dogs with long feathers between pads should have this hair trimmed to help with traction. Raised feeding stations to the level of the shoulders can help with shifting of weight on to painful joints when bending down to eat.  

Rehabilitation 

A certified canine rehabilitation practitioner (CCRP) is vital to improving quality of life in our osteoarthritic patients by reducing pain, improving mobility, and improving strength and endurance. Aquatic therapy, therapeutic exercises, and equipment such as a laser or ultrasound are incorporated into a comprehensive plan to reduce pain. Some patients may be able to reduce or discontinue their daily pain medication. Targeted exercises will improve the joint’s ability to move through its normal range of motion and, therefore, improve function.  Increased strength of muscles and ligaments surrounding affected joints will help to stabilize joints and improve the way arthritic dogs move, which means less pain and less chance of compensatory injuries. This all leads to improved endurance; those daily activities that were a challenge previously may now be pain free. Who doesn’t want to see the hands of time turn back for their senior dog? 

We understand that our clients can feel unsure about anesthesia for their pet, whether their uncertainty is related to their own  experience or stories they have heard from a friend. The thought of anesthesia can be even more worrisome for our clients with  senior pets, causing them to wonder if the risks are greater than the benefit. We do know that age, itself, is not a disease, therefore, it should not be the reason to decline a procedure that can drastically improve quality of life or even be life saving. Senior pets may have hidden illnesses which can increase their risks, but we can modify our anesthetic approach to maximize their safety. We strongly believe surgery plays an integral role in keeping our pets healthy and improving their quality of life so let’s explore some safety measures in place at our hospital to, hopefully, alleviate some of the stress for any pet owner that is facing surgery for their furry family member:

1. One of our doctors will complete a physical exam on your pet the morning of surgery to confirm their vitals are within normal range.
2. Medications used for your pet’s anesthetic protocol are tailored to them, taking into consideration factors such as breed, age, surgical procedure, and health status. This is extremely important with senior pets because drugs are metabolized slower, and we can see more sensitivity to drugs, therefore, we use alternative medications or lower doses.  
3. Preoperative blood work can help to detect any hidden diseases and provides additional information when selecting our drug protocol.  
4. A cardiac ultrasound can be done at the clinic to assess risk before anesthesia for patients with heart murmurs
5. Your pet will have a technician and a doctor devoted to your pet during their procedure and recovery
6. Your pet will have an intravenous catheter placed and intravenous fluids administered during their procedure and recovery to maintain blood pressure and to ensure a quick access for drug administration.  
7. We use various anesthetic monitoring equipment to measure heart rate and electrical rhythm, respiration, blood pressure, oxygen saturation, and temperature. This information allows us to intervene before a serious problem arises. 
8. We can quickly reverse drugs or alter anesthetic depth if there is concern about your pet’s stability under general anesthesia
9. We are careful to avoid hypothermia during and after surgical procedure. Hypothermia decreases cardiac output, respiration rate, and metabolism of drugs, resulting in prolonged recovery
10. We are proactive with pain control and, because your pet can’t talk to us, we use a pain score chart to evaluate their comfort throughout their hospital stay. 

We cannot say anesthesia is risk free but with all the advancements in veterinary medicine, we do know risks are not necessarily as high as you may expect. It may be comforting to know the statistics on anesthesia. Studies have shown the risk of death is less then 1% for dogs and cats. For example, between 2002 and 2004 a study looked at anesthetic and sedation outcomes at various veterinary hospitals and confirmed that small animal anesthesia has become increasingly safe 

The Risk of Death: the Confidential Enquiry into the Perioperative Small Animal Fatalities 

A thorough oral examination is an important part of your pet’s physical examination.  Unfortunately, dental disease is a common concern with many of our pets and can be associated with many subsequent health concerns, such as heart disease, kidney disease, jaw fracture and oronasal fistulas.  As plaque and tartar form on the surface of the teeth, bacteria underneath will cause inflammation along and underneath the gum line.  This inflammation will damage the gingival tissue and erode the bony attachments around the tooth roots, eventually resulting in root exposure, loose teeth, pain, and infection.  Our pets learn to tolerate dental disease and often continue to eat normally while experiencing chronic discomfort.  We assume “doggy breath” is normal for our pets but it’s actually one of the most common signs of dental disease. Other less common signs include excessive drooling, chewing on one side or dropping food, pawing at the face, bleeding or discharge from the mouth, facial swelling and draining tracts, sneezing and nasal discharge, and changes in behavior.  Because our clients may not be looking in their pet’s mouth regularly, our oral examination is extremely important in detecting dental disease. Our doctors may review concerns with you, such as gingival recession, root exposure, excessive tartar, discoloration of teeth, displacement of teeth or oral swelling/masses.  Once dental disease has progressed to include dramatic tooth root attachment loss, there are few options to address the associated pain from the diseased teeth, therefore, extraction is recommended. Although it may be worrisome if your pet needs teeth removed, leaving diseased teeth in the mouth means your pet will continue to be in discomfort and surrounding teeth can also become affected. Fortunately, once their mouths have healed from surgery, they will continue to eat normally. It’s amazing the difference we can see in overall happiness from our patients after a dental procedure. 

Our veterinarians may recommend regular preventative dental procedures when mild dental disease is present or if they have identified significant dental concerns. Many may wonder about the value of a dental cleaning when their pet’s teeth have minimal signs of dental disease. Consider that many of us see our own dentist for cleaning and dental x-rays a few times a year, even though we brush and floss regularly at home.  Imagine how much disease can develop in your pet’s mouth without regular dental care, even from a young age.  It is worthwhile investing in maintaining our pet’s oral health to keep them pain free, as well as avoiding lengthy and costly dental surgeries. On the day of their dental procedure, your pet should arrive fasted.  They will be put under a general anesthesia and monitored closely for the duration of their procedure.  Full mouth dental x-rays will be taken to evaluate the tooth roots and attachments of all teeth.  All healthy teeth will be thoroughly cleaned by a registered technician using our ultrasonic scaler and polished to ensure a smooth surface.  The teeth will be probed for pockets and areas of pain and all findings will be recorded in your pet’s medical record.  If extractions are necessary, these will be performed carefully by one of our skilled veterinarians.  All extraction sites will be closed with absorbable suture material.  Your pets will be discharged later the same day with pain medication and antibiotics if necessary.  We offer complimentary recheck visits 2 weeks after these procedures, to ensure that your pet’s mouth has healed well and to discuss a dental home care program for your pet.  We offer a variety of home care options to suit everyone’s ability and schedule, ensuring that your pet’s mouth continues to be healthy after their procedure.   

Ultrasound imaging uses high frequency sound waves to create an image of the inside of the body. These images give us valuable information, which is why ultrasound has become a standard of care. It’s important to be aware that not all ultrasound examinations are created equal. The quality of the machine, the ultrasound probes used, and the skill of the ultrasonographer are extremely important for generating high quality diagnostic images.  So why has ultrasound become so increasingly important in your pet’s care? Just like our other diagnostic tools, such as x-rays and blood panels, ultrasound gives us a valuable piece of the puzzle when investigating your pet's illness. It can provide vital information in an emergency as well. We can quickly scan for signs of fluid in the abdomen, such as blood.  If abdominal distension is present, we can quickly look for obvious signs of organ enlargement.   For example, the uterus is a common organ that can become enlarged with a life-threatening condition called pyometra.  

Let’s review what happens when your pet has an ultrasound, as well as the benefits and limitations of this technology. One of our doctors may recommend an abdominal ultrasound because your pet is unwell and something abnormal is detected on physical exam, visualized on abdominal/chest x-rays or on blood work. Our doctors responsible for performing the cardiac and abdominal ultrasounds have undergone extensive ultrasound training offered through the Sound Academy of Veterinary Imaging, MiEducation and Heska.  It is likely that you will be asked to fast your pet in preparation for ultrasound.  For abdominal ultrasounds, this is extremely important because food in the stomach and intestines will interfere with a thorough study and acquisition of images. A typical abdominal ultrasound takes approximately 1 hour, during which time your pet will be laying on their back in a comfortable supportive bed. A short acting sedation will be given so your pet can be relaxed and to minimize movement. Hair on the belly is shaved to prevent interference with the ultrasound images. A complete abdominal ultrasound study will assess all organs in the abdomen and look for any changes to their structure. Unfortunately, many disease processes can have similar changes on ultrasound. There may be abnormalities identified that increase our suspicion of a specific disease or illness, but we rely on the patient's complete medical picture to guide our treatment. Many conditions require an examination of the cells themselves either with a fine needle aspiration or biopsy to diagnose.  

For a cardiac ultrasound, your pet will also be fasted the night prior. A mild sedative may be required for relaxation and proper positioning on the cardiac table. The cardiac table is a specialized padded table with windows allowing access to the chest while your pet is laying on their sides. A patch of hair will be shaved on either side of the chest to generate a complete image of the heart and evaluate for heart conditions. Cardiac ultrasound studies will be used to guide treatment and monitoring, as well as assess anesthetic safety and medication selection.   A cardiac ultrasound may be recommended by one of our doctors due to the presence of a new or the progression of an existing heart murmur heard on examination.

All ultrasound images are reviewed by a board-certified radiologist or cardiologist respectively to ensure that subtle changes are not missed and provide valuable expert recommendations on case management. Serial ultrasounds can be used to monitor progression of disease and/or response to treatment.  

Puppy plans are an easy and cost-effective way to pay for your puppy’s initial vaccines, boosters and health exams. Buy as a plan and save 15% compared to paying for each service individually.  You can choose to pay the total upfront, or in 3 equal payments if pet is 8 weeks old or less or 2 equal payments if pet is 9-12 weeks old.  A nail trim and in-house fecal test is included at each booster visit.  

***In case of cancellation, a $50 cancellation fee will apply; the puppy plan will be refunded minus the services used and minus the 15% discount. There are NO exceptions to this rule. ***  

Deworming included is for the most common parasites (roundworms and hookworms).  If other parasites are found and different deworming is required, there will be an additional charge. Rabies is given at the 3rd set of vaccines (final booster).  

Puppy plans require a valid Visa/MC/Visa Debit and are paid via automatic withdrawals through our online store. A $50+tax admin fee will be applied for every declined payment  If your puppy has already received their first round of vaccines, $98 is taken off the plan price. There is no set up administration fee for the puppy plan  

Prices do not include tax.  

Puppy must be 12 weeks old or less (no exceptions)  

Spay/neuter is not included.     

All puppy plan include 1 – 20 ml bottle of Adaptil Spray 

Kitten plans are an easy and cost-effective way to pay for your kitten’s initial vaccines and boosters, and their spay/neuter. Buy as a plan and save 15% compared to paying for each service individually.  You can choose to pay the total upfront, or in 5 equal payments if pet is 8 weeks old or less or 4 equal payments if pet is 9-12 weeks old.  

A nail trim and in-house fecal test is included at each booster visit.

***Please note that surgeries in the plans are for immature animals at 6 months of age or younger.  If you prefer to wait until after 6 months to spay/neuter, this pack is NOT applicable for you. If you delay your pets spay/neuter beyond 6 months, a $50 cancellation fee will apply, the kitten pack will be refunded minus the services used and minus the 15% discount. When you book your pet’s surgery, the regular surgery costs for your pet’s weight range will apply and your pet will require an exam and be up to date on vaccines prior to booking surgery. There are NO exceptions to this rule. ***

Deworming included is for the most common parasites (roundworms and hookworms).  If other parasites are found and different deworming is required, there will be an additional charge. Rabies is given at the 3rd set of vaccines (final booster).

Kitten plans require a valid Visa/MC/Visa Debit and are paid via automatic withdrawals through our online store. A $50+tax admin fee will be applied for every declined payment.

If your kitten has already received their first round of vaccines, $98 is taken off the package price. There is no set up admin fee for the kitten plan.

Kitten must be 12 weeks old or less (no exceptions) 

Prices do not include tax. 

All kitten plans include:
1 – 20 ml bottle of Feliway Spray
Option to test for FIV/FeLV @ 15% off current price