You are on the couch with your pet when you wonder if its necessary to follow-up with your veterinarian after the previous weeks visit. After all, it seems like everything is back to normal, so maybe there’s no need to go back. What you may not realize is that the decision you are making not to follow through could end up being a huge mistake, one that may jeopardize your pet’s health.
Sure your pet might be eating normal again or have their usual energy back but a recheck exam helps ensure that whatever caused the initial problem is truly not an issue anymore. There is also important information to discuss during the visit including medications that were prescribed, the lifting of any dietary or activity restrictions, precautions to prevent reoccurrence and when your pet should be examined next. This is especially important if the problem involves a chronic disease, you will want to make sure all is well now, discuss what to look for as early signs that there might be a problem and have a plan ready for the future.
If your pet is still not 100%, a recheck exam becomes that much more important. It is easy to think that because the problem is still occurring your vet missed the cause or if there was not a definitive diagnosis the first time around why go back to find nothing again. Many times the follow-up exam may reveal further clues that were not present on the initial examination and may be what is needed to figure out your pet’s problem. As a vigilant pet owner, you may spot changes in your pet that no one else would notice, not even your veterinarian. These changes may occur before any specific exam abnormalities can be detected, an indication that the situation is mild and will pass with some time or that it is just the beginning and as the disease progresses further signs to identify the cause will manifest. If your pet was showing non-specific signs before and continues to show them or is now showing new or worse signs, it is imperative that you follow-up. Don’t let the problem drag on to a point where it may become more costly, more complicated or too advanced to intervene.
So the next time you are thinking of skipping the all-important follow-up visit, do what’s best, call and make the follow-up appointment and let the professionals give your pet a clean bill of health.
Showing posts with label exam. Show all posts
Showing posts with label exam. Show all posts
Monday, August 22, 2011
Thursday, August 19, 2010
Feline Chronic Kidney Disease
Video Link from The Cornell University College of Veterinary Medicine: Cat owners guide to kidney disease. Includes tests used to diagnose it, what it is, medications used to manage it and instructions on giving fluids under the skin (subcutaneous fluids).
Kidney disease implies that one or both of the kidneys are not working as they should. It can go undetected until the disease is severe enough to cause clinical signs or changes in blood and urine tests. Other terms used include renal or kidney failure. Kidney disease can be acute (recently occurred and may be reversible) or chronic (has been occurring and progressing for a long time and is not reversible). Sometimes it can be a combination where a patient with stable chronic kidney disease has an acute worsening of kidney function, termed acute on chronic kidney disease.
The kidneys are important for daily function as they eliminate the waste the body produces, make sure electrolytes and water balance and they produce a variety of important hormones including one that helps prevent anemia. Luckily the kidney is made with plenty of “back-up” help. 66% of the kidneys must be damaged to lose the ability to concentrate urine and 75% of the kidneys must be damaged to see elevations in levels of wastes the body clears from the blood. This is why people and animals can donate one kidney and continue to live a normal life, as both kidneys are not necessary if they are completely healthy. One disadvantage is that the “back-up” help makes it difficult to detect kidney disease early on.
The goal of identifying kidney disease early is to attempt to slow its progression. How can you tell at home if your cat may have kidney disease? Early on, your cat will appear normal and healthy. Once 66% of the kidneys are damaged, concentration of the urine (a way the body conserves water) is not possible. A sign of this is that your cat begins to drink more water and urinate more often. You may notice that your cat is always at the water bowl or that you fill it more often than usual. You may also notice that your cat is using the litter box more often or that you are scooping the litter box more frequently.
As the disease becomes more advanced your cat will lose weight, have a poor hair coat and may not eat as well. As the kidney damage progresses body wastes are not eliminated properly and they accumulate in the blood and body. This elevation of toxins can be measured with blood work and when these levels are increased the condition is called uremia which literally means urine in the blood. Signs of uremia include loss of appetite, vomiting, ulcers in the mouth, weakness and bad breath due to the accumulation of ammonia.
Other abnormalities that can occur include anemia (the kidney produces a hormone called erythropoietin that is responsible for making red blood cells), and high blood pressure. The anemia makes the weakness and loss of appetite worse. High blood pressure can cause blindness, stroke-like signs such as changes to behavior or seizures, injury to the heart and worsening of the kidney disease itself.
So how can you identify this disease earlier rather than when your cat is sick? This is where the importance of yearly urine and blood tests during your senior cat’s annual visit comes in. A urine sample will show whether the kidneys can concentrate it appropriately (remember loss of this ability is one of the first indicators of kidney disease). If the kidney is damaged enough or there is high blood pressure proteins will also accumulate in the urine and this can be detected as well. Sometimes, urinary tract infections can affect the kidneys and a urine test can also identify if this is present. A complete blood test is important to monitor not only for two main indicators of toxin accumulation in the body (BUN and creatinine) but also to make sure that anemia is not present. A blood test can also identify electrolyte abnormalities which may require special supplements to correct.
Other tests that should be done during your senior cat’s exam should include a blood pressure. Once kidney disease is identified x-rays and ultrasound are needed to evaluate the kidneys. This evaluation is important in identifying possible kidney stones, abnormalities in size and shape of the kidneys.
Although chronic kidney disease is irreversible, for most cats treatment can “assist” the kidneys and allow a good quality of life for months or years. There is no single treatment for kidney disease. Your veterinarian will tailor make a plan for your cat based on the severity of the changes in the blood work and the signs that your cat is experiencing. Treatments include a “kidney friendly” diet, hydration therapy by giving fluids under the skin, supplements and medications to vomiting, nausea, poor appetite and high blood pressure. If your cat becomes anemic injections of the hormone erythropoietin may be recommended.
Your veterinarian will formulate a schedule for exams that will include re-checking blood work, urine tests and blood pressure. This will assist in making adjustments to the treatment plan.
In humans chronic kidney disease is sometimes managed with hemodialysis (where a machine acts like a kidney and cleanses the blood of wastes) or by kidney transplant, both of which are available for cats but usually not a realistic option for the general cat population due to limits in availability, costs and specific criteria to be an ideal candidate. It is important to remember that hemodialysis is not a cure and those receiving kidney transplants require long-term medication administration to try and avoid rejection of the donated kidney.
Remember, just because your cat seems healthy at home, it is important to see your veterinarian at least yearly for younger cats, every 6 months for senior cats (>7 years old) and that blood work and urine tests be performed in senior patients to try and spot changes before your cat is actually sick!
Kidney disease implies that one or both of the kidneys are not working as they should. It can go undetected until the disease is severe enough to cause clinical signs or changes in blood and urine tests. Other terms used include renal or kidney failure. Kidney disease can be acute (recently occurred and may be reversible) or chronic (has been occurring and progressing for a long time and is not reversible). Sometimes it can be a combination where a patient with stable chronic kidney disease has an acute worsening of kidney function, termed acute on chronic kidney disease.
The kidneys are important for daily function as they eliminate the waste the body produces, make sure electrolytes and water balance and they produce a variety of important hormones including one that helps prevent anemia. Luckily the kidney is made with plenty of “back-up” help. 66% of the kidneys must be damaged to lose the ability to concentrate urine and 75% of the kidneys must be damaged to see elevations in levels of wastes the body clears from the blood. This is why people and animals can donate one kidney and continue to live a normal life, as both kidneys are not necessary if they are completely healthy. One disadvantage is that the “back-up” help makes it difficult to detect kidney disease early on.
The goal of identifying kidney disease early is to attempt to slow its progression. How can you tell at home if your cat may have kidney disease? Early on, your cat will appear normal and healthy. Once 66% of the kidneys are damaged, concentration of the urine (a way the body conserves water) is not possible. A sign of this is that your cat begins to drink more water and urinate more often. You may notice that your cat is always at the water bowl or that you fill it more often than usual. You may also notice that your cat is using the litter box more often or that you are scooping the litter box more frequently.
As the disease becomes more advanced your cat will lose weight, have a poor hair coat and may not eat as well. As the kidney damage progresses body wastes are not eliminated properly and they accumulate in the blood and body. This elevation of toxins can be measured with blood work and when these levels are increased the condition is called uremia which literally means urine in the blood. Signs of uremia include loss of appetite, vomiting, ulcers in the mouth, weakness and bad breath due to the accumulation of ammonia.
Other abnormalities that can occur include anemia (the kidney produces a hormone called erythropoietin that is responsible for making red blood cells), and high blood pressure. The anemia makes the weakness and loss of appetite worse. High blood pressure can cause blindness, stroke-like signs such as changes to behavior or seizures, injury to the heart and worsening of the kidney disease itself.
So how can you identify this disease earlier rather than when your cat is sick? This is where the importance of yearly urine and blood tests during your senior cat’s annual visit comes in. A urine sample will show whether the kidneys can concentrate it appropriately (remember loss of this ability is one of the first indicators of kidney disease). If the kidney is damaged enough or there is high blood pressure proteins will also accumulate in the urine and this can be detected as well. Sometimes, urinary tract infections can affect the kidneys and a urine test can also identify if this is present. A complete blood test is important to monitor not only for two main indicators of toxin accumulation in the body (BUN and creatinine) but also to make sure that anemia is not present. A blood test can also identify electrolyte abnormalities which may require special supplements to correct.
Other tests that should be done during your senior cat’s exam should include a blood pressure. Once kidney disease is identified x-rays and ultrasound are needed to evaluate the kidneys. This evaluation is important in identifying possible kidney stones, abnormalities in size and shape of the kidneys.
Although chronic kidney disease is irreversible, for most cats treatment can “assist” the kidneys and allow a good quality of life for months or years. There is no single treatment for kidney disease. Your veterinarian will tailor make a plan for your cat based on the severity of the changes in the blood work and the signs that your cat is experiencing. Treatments include a “kidney friendly” diet, hydration therapy by giving fluids under the skin, supplements and medications to vomiting, nausea, poor appetite and high blood pressure. If your cat becomes anemic injections of the hormone erythropoietin may be recommended.
Your veterinarian will formulate a schedule for exams that will include re-checking blood work, urine tests and blood pressure. This will assist in making adjustments to the treatment plan.
In humans chronic kidney disease is sometimes managed with hemodialysis (where a machine acts like a kidney and cleanses the blood of wastes) or by kidney transplant, both of which are available for cats but usually not a realistic option for the general cat population due to limits in availability, costs and specific criteria to be an ideal candidate. It is important to remember that hemodialysis is not a cure and those receiving kidney transplants require long-term medication administration to try and avoid rejection of the donated kidney.
Remember, just because your cat seems healthy at home, it is important to see your veterinarian at least yearly for younger cats, every 6 months for senior cats (>7 years old) and that blood work and urine tests be performed in senior patients to try and spot changes before your cat is actually sick!
Wednesday, August 11, 2010
Why do puppies and kittens need a series of vaccines?
When a puppy or kitten is born its immune system has not yet matured. Kittens and puppies remain protected from infection because of the transfer of maternal antibodies in special milk from their mother called colostrum. Colostrum is only produced a few days after giving birth and it can only be accepted during the first days after birth before their intestines “close up” and can no longer absorb the antibodies.
Sometimes antibodies are not transferred either because the puppy did not drink the colostrum or the mother did not have certain antibodies, other times those transferred only last for a short period of time. If an appropriate number of antibodies are transferred there is protection for a longer period of time. However, the maternal antibodies that are transferred do not last forever.
What does this have to do with vaccinations? Well, there is really no way to tell if maternal antibodies were transferred, which were transferred or how long they will last and therefore a vaccination given early will help protect them.
So why not just give one vaccine early and forget about it? If a vaccine is given to a pet that still has maternal antibodies present it will be inactivated and new antibodies will not be made. How long maternal antibodies last in a pet varies with each individual and for specific diseases. We do know that maternal antibodies are gone or have decreased enough to not interfere with vaccines by 16-20 weeks of age. This is why the final booster is usually given at this time when there will be no interference and protection ensured.
So why not just give one vaccine when they are older, when we are pretty sure maternal antibodies will not interfere with vaccines? Again, since there is no easy way to tell if a pet has protection from maternal antibodies at birth or if protection will last until 16-20 weeks of age, waiting to vaccinate until that time puts them at risk of developing dangerous and deadly diseases.
Therefore, vaccinations are given in series every 2-4 weeks until age 16-20 weeks. This is done to protect those that lose maternal antibodies early while ensuring that those that have longer lasting maternal antibodies are protected as well.
What if the pet is older than 16 weeks of age? In this case there is no worry about interference from maternal antibodies, but one booster 2-4 weeks after the initial vaccine is necessary to ensure a better response.
Sometimes antibodies are not transferred either because the puppy did not drink the colostrum or the mother did not have certain antibodies, other times those transferred only last for a short period of time. If an appropriate number of antibodies are transferred there is protection for a longer period of time. However, the maternal antibodies that are transferred do not last forever.
What does this have to do with vaccinations? Well, there is really no way to tell if maternal antibodies were transferred, which were transferred or how long they will last and therefore a vaccination given early will help protect them.
So why not just give one vaccine early and forget about it? If a vaccine is given to a pet that still has maternal antibodies present it will be inactivated and new antibodies will not be made. How long maternal antibodies last in a pet varies with each individual and for specific diseases. We do know that maternal antibodies are gone or have decreased enough to not interfere with vaccines by 16-20 weeks of age. This is why the final booster is usually given at this time when there will be no interference and protection ensured.
So why not just give one vaccine when they are older, when we are pretty sure maternal antibodies will not interfere with vaccines? Again, since there is no easy way to tell if a pet has protection from maternal antibodies at birth or if protection will last until 16-20 weeks of age, waiting to vaccinate until that time puts them at risk of developing dangerous and deadly diseases.
Therefore, vaccinations are given in series every 2-4 weeks until age 16-20 weeks. This is done to protect those that lose maternal antibodies early while ensuring that those that have longer lasting maternal antibodies are protected as well.
What if the pet is older than 16 weeks of age? In this case there is no worry about interference from maternal antibodies, but one booster 2-4 weeks after the initial vaccine is necessary to ensure a better response.
Monday, August 9, 2010
Xylitol Toxicosis In Pets
Xylitol is a commonly used sugar substitute that is as sweet as sugar with only two-thirds its calories. It is frequently found in sugar-free gum, candy, baked goods, desserts, and toothpaste. In people, xylitol is a safe compound with few associated side effects however it may have significant adverse effects in dogs. The ingestion of xylitol has been associated with a severe drop in blood sugar (hypoglycemia) and acute liver failure.
Signs of low blood sugar have been noted as soon as 30 to 60 minutes after ingestion as it is rapidly and almost completely absorbed! Why is there such a drop in blood sugar? Xylitol causes a rapid, significant increase in insulin secretion in dogs and insulin causes the blood sugar to decrease.
Acute liver failure can also become evident up to 72 hours after ingestion. Although there are two thoughts as to how this occurs it is not exactly known how this happens. It is believed that products produced by the liver when breaking down the xylitol cause severe damage. One toxic by-product depletes the liver cells of their energy source while the other reactive product damages the cell membranes, both leading to cell death.
If liver injury occurs after Xylitol ingestion the prognosis is unfortunately poor. A study revealed that 63% of dogs that ate xylitol containing products died despite aggressive medical management. Interestingly, the dose ingested does not equal whether one pet or another will develop liver failure.
If you noticed your pet eat something they weren’t supposed to, look at the ingredients. If xylitol is listed on the product bring the product packaging and your dog to the veterinarian immediately. If your dog recently ate a xylitol containing product your veterinarian can induce vomiting to try and get out as much of the product as possible. The vomiting may not be effective if ingestion was not within the past 30 to 60 minutes as xylitol is quickly absorbed by the body.
Signs of xylitol toxicosis include vomiting, diarrhea, a drunken gait, coma, and seizures. Sings of low blood sugar can occur within 30-60 minutes and if liver failure occurs signs are usually evident within 12 to 72 hours of ingestion.
Dogs have a better prognosis if improvements in blood work abnormalities related to the liver and stabilization of the blood sugar levels occur as well as lack of progression to acute liver failure within 3 days of ingestion.
It is therefore important to make sure that your xylitol containing products be kept away from your pets. It only takes a quick second for your dog to jump on the counter and eat the package of sugar free gum you just purchased. If this occurs call your vet immediately and don’t forget the package on your way out.
Signs of low blood sugar have been noted as soon as 30 to 60 minutes after ingestion as it is rapidly and almost completely absorbed! Why is there such a drop in blood sugar? Xylitol causes a rapid, significant increase in insulin secretion in dogs and insulin causes the blood sugar to decrease.
Acute liver failure can also become evident up to 72 hours after ingestion. Although there are two thoughts as to how this occurs it is not exactly known how this happens. It is believed that products produced by the liver when breaking down the xylitol cause severe damage. One toxic by-product depletes the liver cells of their energy source while the other reactive product damages the cell membranes, both leading to cell death.
If liver injury occurs after Xylitol ingestion the prognosis is unfortunately poor. A study revealed that 63% of dogs that ate xylitol containing products died despite aggressive medical management. Interestingly, the dose ingested does not equal whether one pet or another will develop liver failure.
If you noticed your pet eat something they weren’t supposed to, look at the ingredients. If xylitol is listed on the product bring the product packaging and your dog to the veterinarian immediately. If your dog recently ate a xylitol containing product your veterinarian can induce vomiting to try and get out as much of the product as possible. The vomiting may not be effective if ingestion was not within the past 30 to 60 minutes as xylitol is quickly absorbed by the body.
Signs of xylitol toxicosis include vomiting, diarrhea, a drunken gait, coma, and seizures. Sings of low blood sugar can occur within 30-60 minutes and if liver failure occurs signs are usually evident within 12 to 72 hours of ingestion.
Dogs have a better prognosis if improvements in blood work abnormalities related to the liver and stabilization of the blood sugar levels occur as well as lack of progression to acute liver failure within 3 days of ingestion.
It is therefore important to make sure that your xylitol containing products be kept away from your pets. It only takes a quick second for your dog to jump on the counter and eat the package of sugar free gum you just purchased. If this occurs call your vet immediately and don’t forget the package on your way out.
Friday, July 30, 2010
Performing a brief monthly at-home exam on your pet
Just as physicians recommend monthly self-examinations for men and women (whether we do perform them or not is another story), I recommend a brief at-home monthly check-up of your pets. This of course DOES NOT replace the more thorough 6-12 month check-ups recommended by your veterinarian (more frequently if your pet has a health problem). The purpose of these brief at home exams is to identify changes in your pet that may require you to see your veterinarian sooner than the previously scheduled check-up.
A great time to do this is before you apply the monthly flea/tick/heartworm preventative medication and it should only takes a few minutes. The more routinely you perform this the easier it will be for you to note when changes do occur.
Just as I start my exams in the office, step back for a moment and just watch your pet. Do they seem to breathing comfortably? Do they appear too thin or overweight? Do they have trouble laying down and getting up? This is a good time to go over and answer the important questions your veterinarian will ask (see previous blog post “10 important questions your veterinarian will ask that you should be prepared to answer”).
I then recommend starting at the face and working your way to the tail. Observe for any discharge or redness of the nose, eyes or ears. If discharge is seen, note which side is affected and the amount and color of the discharge.
Next, if your pet allows, gently lift the lip on each side and note any tartar on the teeth, broken or discolored teeth or changes to the gum color. Healthy gums should be a nice pink color. Bright red gums along the border of tartar covered teeth may signify gingivitis. Some pets have pigmented gums and these changes may be difficult to assess. If you notice pale, blue/purple or yellow gums it is best to call your veterinarian and have your pet assessed further as they may have a serious medical condition.
Next, move your hands along the neck to the shoulders, down each front leg and back up and down the rest of the chest and abdomen finally reaching the back legs. As you do this you should be feeling for any lumps, bumps or painful areas. Three areas to check as you move from head to tail are at the end of the jaw just below the ears, in front of the shoulders, and behind the knees. Major lymph nodes are located in these areas and any changes to their size may indicate inflammation, infection or cancer. You can ask your veterinarian to demonstrate where you should be feeling during your next visit.
If lumps are encountered they are most likely lipomas or "fatty growths" that don’t cause a problem unless they get too large and infiltrate adjacent areas BUT lumps that look and feel like "fatty growths" can also be dangerous cancerous lumps. The only way to tell the difference is to have your veterinarian sample them. This is easily done as we poke the lumps with a needle and apply the cells on a slide (fine needle aspirate). Your veterinarian may look at it under the microscope in their office or send it to the lab so a pathologist can analyze the cells. Obtaining this aspirate is not 100% as only very few cells are sampled, but is a good start in helping decide if this lump should be removed immediately or if it is ok to monitor it for changes in size and appearance. Your veterinarian will note the size and location of the lump in the record to keep track of it during future visits. Sometimes depending on the location, feel and look of the lump it may be recommended to remove a piece of the lump and send it to the pathologist instead of performing an aspirate or after an aspirate.
Once you reach the tail, again if your pet allows it, lift the tail and examine for any discharge, nodules or uneven, bumpy areas around the anus. Tumors involving the anal glands can occur and go unnoticed until it is so large that your pet has trouble defecating and by that time it has most likely spread. In female dogs you can monitor for any discharge from the vulva.
Finally, if your pet is good about laying on its side or back, examine the hairless areas of the belly for any rashes, redness, fleas or mammary growths. Run your hands along their bellies and note any lumps and bumps. In male dogs this is a good time to notice any discharge from the penis.
This simple and quick exam will help you identify any possible changes to your pet’s health earlier, instead of waiting months for the next scheduled exam. Recognizing these changes early may save your pets life, allow for a possible cure or at least be able to start important medications before the disease becomes too advanced. It also helps your pets get used to a part of the more thorough examination that your veterinarian will perform. As always, if you have any concerns about your pet, please call your veterinarian first for further advice before ignoring a problem, misdiagnosing a problem or self-medicating your pet as you may be causing more harm than good!
A great time to do this is before you apply the monthly flea/tick/heartworm preventative medication and it should only takes a few minutes. The more routinely you perform this the easier it will be for you to note when changes do occur.
Just as I start my exams in the office, step back for a moment and just watch your pet. Do they seem to breathing comfortably? Do they appear too thin or overweight? Do they have trouble laying down and getting up? This is a good time to go over and answer the important questions your veterinarian will ask (see previous blog post “10 important questions your veterinarian will ask that you should be prepared to answer”).
I then recommend starting at the face and working your way to the tail. Observe for any discharge or redness of the nose, eyes or ears. If discharge is seen, note which side is affected and the amount and color of the discharge.
Next, if your pet allows, gently lift the lip on each side and note any tartar on the teeth, broken or discolored teeth or changes to the gum color. Healthy gums should be a nice pink color. Bright red gums along the border of tartar covered teeth may signify gingivitis. Some pets have pigmented gums and these changes may be difficult to assess. If you notice pale, blue/purple or yellow gums it is best to call your veterinarian and have your pet assessed further as they may have a serious medical condition.
Next, move your hands along the neck to the shoulders, down each front leg and back up and down the rest of the chest and abdomen finally reaching the back legs. As you do this you should be feeling for any lumps, bumps or painful areas. Three areas to check as you move from head to tail are at the end of the jaw just below the ears, in front of the shoulders, and behind the knees. Major lymph nodes are located in these areas and any changes to their size may indicate inflammation, infection or cancer. You can ask your veterinarian to demonstrate where you should be feeling during your next visit.
If lumps are encountered they are most likely lipomas or "fatty growths" that don’t cause a problem unless they get too large and infiltrate adjacent areas BUT lumps that look and feel like "fatty growths" can also be dangerous cancerous lumps. The only way to tell the difference is to have your veterinarian sample them. This is easily done as we poke the lumps with a needle and apply the cells on a slide (fine needle aspirate). Your veterinarian may look at it under the microscope in their office or send it to the lab so a pathologist can analyze the cells. Obtaining this aspirate is not 100% as only very few cells are sampled, but is a good start in helping decide if this lump should be removed immediately or if it is ok to monitor it for changes in size and appearance. Your veterinarian will note the size and location of the lump in the record to keep track of it during future visits. Sometimes depending on the location, feel and look of the lump it may be recommended to remove a piece of the lump and send it to the pathologist instead of performing an aspirate or after an aspirate.
Once you reach the tail, again if your pet allows it, lift the tail and examine for any discharge, nodules or uneven, bumpy areas around the anus. Tumors involving the anal glands can occur and go unnoticed until it is so large that your pet has trouble defecating and by that time it has most likely spread. In female dogs you can monitor for any discharge from the vulva.
Finally, if your pet is good about laying on its side or back, examine the hairless areas of the belly for any rashes, redness, fleas or mammary growths. Run your hands along their bellies and note any lumps and bumps. In male dogs this is a good time to notice any discharge from the penis.
This simple and quick exam will help you identify any possible changes to your pet’s health earlier, instead of waiting months for the next scheduled exam. Recognizing these changes early may save your pets life, allow for a possible cure or at least be able to start important medications before the disease becomes too advanced. It also helps your pets get used to a part of the more thorough examination that your veterinarian will perform. As always, if you have any concerns about your pet, please call your veterinarian first for further advice before ignoring a problem, misdiagnosing a problem or self-medicating your pet as you may be causing more harm than good!
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