Surprise Diagnosis – Importance of Early Disease Detection Screening

Autumn, a 12 year old dog came to see us because she seemed to have problems with her hind end. Her owner was worried about her hips because she was having trouble walking and especially on the stairs. Sure enough in the exam room, she seemed to be crouching as she walked and was uncomfortable. We were suspicious of arthritis due to her age and decided to go ahead with Early Disease Detection.

This is labwork that we use in older pets to screen for multiple diseases that are more common in our seniors. This can include kidney disease, liver disease, diabetes, cushings disease, anemia, infection and abnormalities with minerals and electrolytes. A urinalysis is also included for our senior animals.

Animals cannot communicate with us to let us know how they are feeling or where it hurts. The labwork we checked at Autumns visit was also going to provide us with baseline values before starting her on an anti-inflammatory for arthritis.

Much to our surprise, Autumn had a severe urinary tract infection. She uses a doggy door into her backyard at home so during the summer months her owner does not see her bathroom habits. Once we started her on antibiotics and anti-inflammatories for the infection and discomfort, Autumn improved tremendously. Her mobility is back to normal.

We rely on labwork in addition to a good patient history and complete exam to help us treat our patients that cannot speak!

To learn more about our Early Disease Detection in senior pets, please call us at (902) 893-2341

 

Edith’s Story – Orthotics To The Rescue

Meet Edith Anne and her very noble and tolerant big brother, Bishop. Edith Anne is  9 1/2 years old and has always played the pleasant but somewhat annoying loving little sister to Bishop (11 1/2 years).

Over the last year, poor Edith’s arthritis in her carpi (wrists) have caused a significant deformity to her front legs making it very difficult to walk, let alone run and play. She looked like a little stubborn old women hobbling about but still refusing to give up.

We took X-rays and her condition had gotten much worse. The deformity to her wrist joints was putting more strain on her damaged joints, making the degeneration escalate and creating more pain.

Her Dad, Earle, wanted her to have an active life to enjoy; so we called in Jeff Collins of K9 Orthotics. Jeff is a trained registered prosthetic technician and has a prosthetic limb himself. He personally understands what’s it like to be on the receiving end of a prosthetic device. http://www.k-9orthotics.com/

Edith Anne visited Jeff in early March. Jeff and his team designed and built braces for Edith Anne’s front legs. During the two weeks it took to get the braces made, Earle started wrapping Edith Anne’s legs with a bandage material to get her used to the feeling of a brace.

Once Earle got the braces, he started to apply the braces for hour or so three times a day. Jeff showed Earl how to adjust the tension on the strap to make it comfortable for her and what to watch for if there were problems. 

Earl said: “It takes a while to get the tension correct on the velcro straps – the blend between too tight (blood flow)  and too loose (chafing and lack of support ). She flops on the couch every morning and night to get braces on and off. This makes her dad’s back feel a little better. ”

Within a week Edith wore them up to 10 hours a day. It didn’t take long for little Edith to start pestering brother, Bishop although there was still an obvious lameness to her gait, her attitude was back!

Now, a month later, Edith can wear the braces for a full day. She is back in true form with Bishop enjoying playing with her again and she doesn’t look lame … just happy … really really happy!

Thanks Jeff of K9 Orthotics! You made Edith young again and gave Bishop back a play mate.

 

 

Brenley – The Super Dog

Written By: Ashley Weatherbee, Vet Assistant

In 2012 my partner and I added to our family. We drove to Springfield, Massachusetts and picked up our new 9 week old Bullmastiff puppy.  She was perfect and we fell in love immediately!  She has stolen the hearts of everyone she’s met, including all my co-workers here at the Truro Veterinary Hospital.  From the very beginning, we had plans for her.  She’s graduated obedience classes, been to rally-o classes, and we still have hopes of her, one day, becoming a therapy dog.  Her personality is amazing!

 

 

Working in the veterinary industry, I know how challenging and important it is to have blood donors. Truro Veterinary Hospital looks for dogs who weigh 23 kg or more but are not overweight, are aged between 1-8 years, are up to date on vaccines, are in general good health, and possess a good temperament. Females must be spayed and have never whelped a litter of puppies.  Brenley fit these criteria perfectly!

The procedure of being a blood donor is short and not very painful. In preparation for blood collection, a small amount of hair is shaved from the donor’s neck and the area is cleaned well with a disinfectant.  The blood is collected from the donor’s jugular vein.  The collection takes about 5 minutes, with 1 unit of blood (approximately 450 mL) collected.  Dogs need to remain calm for the procedure and in some cases, mild sedation may be necessary.

Being a parent of a donor participant comes with a commitment. We have agreed to be contacted any time, including the middle of the night in the event of an emergency.  Brenley is kept up to date with her vaccinations, dewormed monthly and has routine bloodwork yearly.  We also had her blood typed, but that is not necessary to become a donor.

 

 

In veterinary hospitals, like any human hospital, we come across cases where a patient needs a blood transfusion. Truro Veterinary Hospital has a Canine Blood Donor Program in place to aid in these emergency situations.  Blood transfusions are needed for various reasons.  These include trauma from motor vehicle accidents, supportive therapy during and after surgery, supporting dogs with bleeding disorders, and treating conditions such as parvovirus, anemia, and poison ingestion.

In June 2014, Brenley was called upon to help Bully.  Bully is an American Bulldog and at the time he was 7 years old.  His mom got a call from Doggie Day Care; he was not himself!  They believed his abdomen seemed big and he was drooling more then normal.  The Day Care brought him to us immediately where his mom was here waiting on his arrival.

Doctor Melissa assessed him upon his arrival. He was retching (non-productive vomiting), and his abdomen did indeed look distended.  Radiographs confirmed his stomach was bloated (filled with gas). A stomach tube was inserted, removing liquid and some gas.  Although this made him more comfortable, he was still retching.  Blood was drawn, we repeated radiographs, and his stomach was now twisted, a dangerous condition called Gastric Distention and Volvulus, or GDV.  He needed emergency surgery.  His life was in danger!

Doctor Gwen performed a gastrotomy procedure. She removed lots of food and hotdog pieces, and could correct the torsion and secure his stomach with a gastropexy.  Bully’s surgery was a success, but he was not out of the woods yet. Doctor Gwen was checking on Bully throughout the night.  He became weak, able to stand and walk but was unsteady.  His breathing was heavy and shallow, unlike his normal deep slow breaths.  He was monitored very closely!  Doctor Gwen requested repeat bloodwork to see if anything had changed.  The results showed his packed cell volume or PCV (the amount of red blood cells in his system) was low.  Before surgery, it was at 40% (normal 37% to 55%) and after surgery it had dropped to 24% with all other blood work normal.  Brenley was needed!

 

I brought Brenley with me to work that day. Because this was her first time donating, we decided to sedate her and she donated 1 unit of blood to aid in Bully’s surgery recovery.  Throughout the day, Bully’s transfusion ran and Brenley recovered from her sedation.  A post transfusion PCV was run, and it was now 28%.  Still not in the normal range, but an improvement! Brenley came home with me after my work day.  She slept most of the evening, getting up to eat her supper and go outside for bathroom breaks.  The following morning, she got up as if nothing happened.  The only sign she had from donating blood was a shaved mark on her neck.

Doctor Gwen monitored Bully though the night and morning. His PCV the following day remained at 28% and he seemed to be feeling better.  Happy that his PCV maintained, he was started on medications to help with his stomach, fed small frequent meals, and he was slowly weaned off his intravenous fluids during the day.

The following day and three days after surgery, Bully was stable enough to be discharged into the care of his owner. This year, 2017, is three years after Bully’s blood transfusion.  He will also be celebrating his 10th birthday.

 

 

If you are interested in having your pet become a blood donor or you would like more information on Truro Veterinary Hospital’s Canine Blood Donor Program, please call our office at 902-893-2341.

 

 

 

 

 

 

 

SUGAR FREE CAN BE TOXIC!

rileyThis is Ripley, an 8yo German Shepherd that came to us after sneaking into his owners luggage and eating ~24 pieces of Pur gum. Thankfully she realized quickly what had happened and brought him in for immediate treatment.

Xylitol is a sugar substitute used in gum, toothpaste and even peanut butter. In dogs it causes a large release of insulin, which causes severe hypoglycemia (low blood sugar). In higher doses it can cause acute liver failure. Many products do not list the actual xylitol amounts. In Ripley’s case, only 4 pieces of the gum he ate would have caused symptoms of hypoglycemia including weakness, tremors and/or seizures. Fortunately we induced vomiting and retrieved 21 pieces of gum! After having his blood sugar monitored for several hours, he was cleared to go home. For many toxins, we can use activated charcoal to bind anything that is not vomited before it gets absorbed. Unfortunately this does not work for xylitol. If absorption did happen in Ripley’s case, we would have started intravenous fluids with added dextrose to keep his blood sugar in the normal range. We are all so thankful that he is doing very well!

It does not take very much xylitol to make a dog seriously ill. It can be life threatening. Read labels, avoid keeping these products in your home and if inadvertent ingestion occurs, seek veterinary care immediately.

If you have any questions, call us at Truro Vet (902) 893-2341

gum

 

A DAY IN THE LIFE OF A ……VETERINARIAN

Written By: Dr Melissa

6:30 am – Time to start my day! I’m scheduled to work a surgery shift today which means I need to be at work for 8am . That gives me an hour and a half to get myself and our three kids ready and out the door. I get my own dog and cat fed and cared for before heading in to the clinic.

8am – I’ve arrived to see what’s in store for the day. We usually have several elective surgeries booked (this means they have been planned for – ie. spay, neuter, dentistry etc.) I will however, be the only veterinarian in the office until noon, so if there are any animals that need to be seen more urgently I will take care of them as well. My routine surgery days are Wednesdays and my team on that day has started calling them ‘Wacky Wednesdays’ as we seem to attract a great variety of ailments!

My first patient to assess is Tucker. He is a young dog with a history of eating facecloths and socks, was hospitalized overnight and needs repeat radiographs to assess for a possible foreign body. He is not really interested in his breakfast and seems nauseated.

Next is Gooch, an Australian Shepherd that had routine surgery last week and wasn’t feeling well yesterday. He has been vomiting and passing bloody diarrhea. Radiographs showed a gas pattern in his intestines that was concerning for a foreign body. This is not always clear cut as many foreign bodies are not easy to see on a radiograph. We treated his symptoms with medication overnight and he is back this morning to repeat the pictures. Luckily he is feeling much better and the radiographs have shown a big improvement. He goes on his way with his relieved Mom.

Hank, a large German Shepherd that was neutered last week arrives to recheck his incision. He has significant swelling at the surgery site. He is very active and therefore very hard to keep quiet at home. He is really uncomfortable and doesn’t even really want me to look at it! With his Mom’s reassurance I’m able to assess things well enough that I decide to start him on antibiotics and extra pain medication. I talk with the owner about the possibility of him needing more surgery to investigate the problem a bit further.

Meanwhile, Tucker’s radiographs have been done and they look very suspicious for a foreign body. This along with his history of eating things he shouldn’t makes me recommend exploratory surgery. I’m worried that his bowel is obstructed. His owner gives us the go-ahead so we get him sedated and prepped for surgery. After his sedative he vomits a couple of liters of foul fluid…nothing glamourous about this job! Although I don’t mind cleaning up body fluids, I work with an amazing team that jumps right in and gets it done :0). We all have our thing that we really don’t like (mine is phlegm), and usually someone will offer to take over!

Next we see Lilli, a young shih tzu who is here for bloodwork to check her liver function. She had routine pre-surgical bloodwork last week prior to her spay and we found some abnormalities. Her surgery was postponed until we can look into the cause for those a bit further. She’s been fasted overnight. She is really wiggly, but with some head pats and excited chatter to distract her, we collect blood and feed her some breakfast. She’ll need a second blood collection in 2 hours.

By 10am, Tucker is ready for surgery. Although we have a few other pets that were booked for procedures today, Tucker gets pushed to first in line since he is sick. I find a sock obstructing his small intestine. Some of the bowel tissue has poor blood supply and is starting to die. I have to remove ~30cm of bowel and attach the two ends. (we call this a resection and anastomosis) This makes the surgery higher risk. There is more chance of infection and incision breakdown. Thankfully Tucker is young and otherwise healthy so this improves his chances of recovering well. These cases are the ones I think about before I go to sleep and first thing when I wake up.

As Tucker recovers from anesthesia, Valor, a young German Shepherd, is ready to be neutered. He’s a beautiful boy and very well mannered. Everything goes routinely.

Over lunch I take some time to call Tucker’s owner to update them on his surgery. I update Valor’s Mom as well. Lilli gets to go home. After checking through my phone messages and returning a few calls to clients I grab a quick bite to eat.

It’s now early afternoon and Boomer, a 7 year old hound that was adopted by his current owner this year is getting prepped for his neuter and dental surgery. On his pre-surgical exam I noticed he had quite a lot of dental tartar and several teeth that looked diseased. Our plan today after he is neutered is to scale and polish his teeth, and take dental radiographs to assess the roots of his teeth for disease that we can’t see above the gumline. His teeth clean up very nicely, and on radiographs I see 5 teeth that need to be extracted. There is bone loss around the roots and they are losing their attachment to the gums. This make it easier for bacteria to invade and infect the roots. I extract the teeth and place sutures that will dissolve over the next two weeks.

Tucker is recovering well… he even eats some gastro canned food for me! (this is a special diet that is bland and used for pets with an upset belly). His parents come for a visit – he definitely perks up when he sees them. We are cautiously optimistic that his recovery continues to go well.

As the shift comes to an end, I write up all the medical files from today, finish updating the owners of surgery patients and return more phone calls that have come up. I update the evening veterinarian on my patients that will stay in-hospital overnight.

I head out to pick up my kids and get them home for the evening.

At midnight I head back in to the clinic to check on Tucker. Thankfully he is feeling very well, getting more energetic and has a great appetite!

My days can be busy and varied, and I consider myself lucky to be working in a field where I learn something new every day. There are many days that we deal with very difficult, emotional situations, but seeing patients head home feeling well is so rewarding it makes up for it.


Tucker’s radiographs – notice the gas in the stomach, this is a common sign when there are obstructions.

Dr Melissa performing surgery on Tucker and Ashley assisting by holding a section of the GI tract.

Dr. Melissa holding a section of the GI tract.

Gooch feeling better after some medication.

Valor waiting for his turn with Dr. Melissa.

One of the many teeth in Boomer’s mouth that needed extracted. To the right side of the image is the jaw, notice the black void around the tooth root – there is supposed to be bone there but instead the root is fully exposed.

Tucker feeling MUCH better at his two week recheck!
 

Get Enlightened about LASER Therapy

Veterinarians have learned a lot about how animals experience pain over the last thirty years.

When I graduated from vet school in 1985, we were instructed that animals feel less pain and handle pain much better than their human counterparts. We were told that a little pain is OK because it discourages activity and that the resulting rest helps healing.

That made a little sense but it still didn’t feel right to me.

Veterinarians are taught comparative anatomy in the early years of vet school. We look at the body systems of many species and compare their development and function.  There is very little difference in the function and nervous systems of all mammalian species – this includes us and our furry friends.

If we feel pain … then your pet feels pain to the same degree. They just can’t communicate their pain and THAT is the problem.

Vets and animal technicians are getting better at identifying pain and more importantly treating pain appropriately. Thankfully, information and aids to treat pain have exploded over the last 15 years. Vets have many ways to treat pain.

At Truro Vet, we have a new cutting edge, scientifically proven way to treat pain … LASER therapy.

You might ask – how, on earth doe light waves treat pain?

Answer is PHOTO-BIO-MODULATION.

There has been a lot of interesting research in this field called photo- bio- modulation lately.

In a nutshell, laser therapy accelerates the body’s natural healing process through photo-bio-modulation. Laser therapy provides tangible health benefits to your pet. Laser therapy is effective in treating chronic conditions, acute conditions, and post- surgical pain and inflammation.

How does it work?

Decades of research, clinical trials, and laboratory testing indicate the following beneficial effects of laser therapy. Some of this is ‘tech talk’ so I translated in the italics at the end of each paragraph:

Anti-Inflammation
Laser therapy reduces inflammation with vasodilation, activation of the lymphatic drainage system, and reduction of pro-inflammatory mediators. As a result, inflammation, erythema, bruising, and edema are reduced.
Reduce the swelling – reduces the pain.

Analgesic Effect
Laser therapy of diseased and damaged tissue produces a suppression of nociceptors, an increase of stimulation threshold, and an increased release of tissue endorphins. The result is a decreased patient perception of pain.
Numbs the nerves so they send less messages to the brain that feels like pain.

Accelerated Tissue Repair and Cell Growth
Photons of light from lasers penetrate deeply into tissue and accelerate cellular reproduction and growth. Laser light increases the energy available to the cells so that they can take on nutrients and get rid of waste products more quickly.
Promotes cell growth and speeds healing.

Improved Vascular Activity
Laser light significantly increases the formation of new capillaries in damaged tissue. This speeds the healing process, resulting in more rapid wound closure.
More blood supply allows the building blocks of repair travel to the diseased treated area faster.

Increased Metabolic Activity
The energy from photons of laser light is captured by chemical complexes within cells resulting in activation of enzyme systems and increased energy delivered into cellular metabolic processes.
If healing cells have more energy – they can speed up the healing process.

Trigger Points and Acupuncture Points
Laser therapy stimulates muscle trigger and acupuncture points without mechanical invasion to provide musculoskeletal pain relief.
Needleless acupuncture.

Reduced Fibrous Tissue Formation
Laser therapy reduces the formation of scar tissue.
More healing and less scars – on the skin and inside the body.

Improved Nerve Function
Slow recovery of nerve functions in damaged tissue results in numbness and impaired limbs. Laser therapy accelerates nerve cell regeneration.
Speeds up the growth and repair of damaged nerves.

Immunoregulation
Therapy laser photons have an effect on immune systems status through stimulation of immunoglobins and lymphocytes. Laser therapy energy is absorbed by chromophores (molecular enzymes) that react to laser light. The enzyme flavomono-nucleotide is activated and starts the production of ATP, which is the major carrier of cellular energy and the energy source for all chemical reactions in the cells.
Increases energy of cells that support the immune system.

Faster Wound Healing
Laser light stimulates fibroblast development. Fibroblasts produce collagen, which is predominant in wound healing in damaged tissue. Collagen is the essential protein required to replace old tissue or to repair tissue injuries. As a result, laser therapy is effective on open wounds and burns.
Faster healing – this is especially obvious on patients with skin wounds or skin disease.

 

What Does Pain Look like in your Dog?

You are in the best position to look for subtle changes of behaviours that indicate your pet is in pain. If your pet is showing one or more of these behaviours he/she maybe hurting. By completing this assessment, you are helping us to identify possible painful conditions.

dog-pain

 

Please check all that apply:

Vocalizing:

  • Whining
  • Howling 
  • Whimpering 
  • Yelping 
  • Groaning 
  • Grunting 

Daily Habits:

  • Decreased Appetite  
  • Withdraws from social interaction 
  • Changes in sleeping (more or less)  
  • Changes in drinking 
  • Lapses in house training or struggles to get into the position 
  • Seeks more affection then usual 

Self Mutilation:

  • Licking one or more areas obsessively of his/her body 
  • Biting at one or more areas of his/her body 
  • Scratching a particular part of his/her body 

Activity Level:

  • Restless, pacing 
  • Repeatedly gets up and lies down; can’t seem to get comfortable 
  • Difficulty lying down or getting up 
  • Trembling, circling or lying very still 
  • Moves stiffly or slowly after exercise or sleeping/resting 
  • Less energy or activity 
  • Reluctant to move 
  • Less playful or willing to exercise 
  • Less eager to jump on furniture or into the car 
  • Difficulty in walking or running; particularly on wood or tile floor or stairs 

Facial Expressions:

  • Grimaces or vacant stare 
  • Glazed, wide eyed or sleepy 
  • Enlarged pupils 
  • Flattened ears 
  • Pants excessively at rest 

Self Protection:

  • Protects a body part 
  • Doesn’t put weight on a leg 
  • Limps 
  • Doesn’t want or avoids being held or picked up 

Posture:

  • Hunched with hind quarters raised and front end down on the ground 
  • Lays on his/her side 
  • Walks with an arched back 
  • Nails worn unevenly or extremely long 

Please list any other changes that are note listed above:

________________________________________________
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What Does Pain Look like in your Cat?

You are in the best position to look for subtle changes of behaviours that indicate your cat is in pain. If your kitty is showing one or more of these behaviours he/she maybe hurting. By completing this assessment, you are helping us to identify possible painful conditions

Please check all that apply:

Vocalizing:

meow

  • _____ Meowing more then usual
  • _____ Purring that seems to be associated with pain
  • _____ Hissing
  • _____ Growling
  • _____ Vocalizes differently, makes noises that are not normal for him/her

Daily Habits:

drink

  • _____ Decreased Appetite
  • _____ Withdraws from social interaction with family members or other animals
  • _____ Changes in sleeping (more or less); sleeps in unusual positions, not curled up; sleeps in abnormal locations (that may be easier to get to, avoiding jumping)
  • _____ Changes in drinking habits
  • _____ Urinates or defecates outside the litter box, has difficulty getting into and out of the box, unable to squat
  • _____ Constipated
  • _____ Won’t groom or grooms less, fur looks unkempt
  • _____ Licking, biting or over grooming a particular body part

Activity Level:

gattoscatola

  • _____ Restless
  • _____ Reluctant to move or moves slowly or stiffly
  • _____ Trembles or shakes
  • _____ Limps
  • _____ Less active; play or hunts less
  • _____ Avoids jumping; can’t jump as high as previously
  • _____ Avoids or has difficulty on stairs
  • _____ Seeks more affection
  • _____ Hides

Posture:

nails

  • _____ Generally lays with feet underneath
  • _____ Crouches for long periods and doesn’t move
  • _____ Reluctant to sharpen claws or stretch
  • _____ Walks stiffly with back arched
  • _____ Overgrown nails, doesn’t sharpen them

Facial Expressions:

pupils

  • _____ Glazed, wide eyed or sleepy
  • _____ Enlarged pupils
  • _____ Squints eyes

 

 

Self Protection:

iStock_000015251643XSmall

  • _____ Protects a body part
  • _____ Doesn’t put weight on a leg
  • _____ Doesn’t want or avoids being held or picked up or patted

 

 

Aggression:

why-do-cats-hiss0

Especially in a previous friendly cat

  • _____ Acts out of character
  • _____ Growls, hisses or bites
  • _____ Pins ears back
  • _____ Is aggressive to humans or other cats

Please list any other changes that are note listed above:

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For a Printable Copy: Pain in cats

 

Pets and Parasites: The Pet Owner Resource

Courtesy of Dr. Michelle

38717981707304716We know that choosing the right parasite prevention product for your pet can be overwhelming. These days, there are so many products to choose from.. pills and topicals.. products that get fleas, ticks, intestinal parasites, and any combination of those! We are always happy to help you make an informed decision on which product is best for your furry family based on your lifestyle, risk, and desired method of administration. Here is a very simplified chart of the major products we carry and their main features. There are a few other products left off of this chart for simplicity sake, but may be mentioned to you in our office if we feel like it is the best product for your pet. Please give us a call (902)893-2341 if you have any questions about these products or would like one of our knowledgeable staff members to help make a recommendation for you.

parasites

 

Vaccinations – Why Are They So Important?

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Courtesy of: Dr. Melissa

A very important part of preventive care for your pet is keeping them up to date on their vaccines. Many people ask us whey their pets need yearly vaccines when people get boosters much less frequently. At our hospital we follow the American Veterinary Association Vaccination Guidelines. These are based on studies to determine how long vaccinations are protective to our pets.  Puppies and kittens generally get three vaccines between 8-16 weeks of age, with a booster on all of these one year later. Core vaccinations are then given to all pets  separately on a rotating 3-year schedule. These vaccines protect against Rabies, Distemper, Parvo, Panleukopenia, Herpes and Calicivirus. Some of our vaccines are given only to those pets whose lifestyle puts them at risk for specific disease, like cats that go outside, or dogs that live in rural areas. These are given yearly and include Feline Leukemia, Leptospirosis, Bordetella (kennel cough) and Lyme.

The diseases we vaccinate for can be very serious, even life threatening. Some of these diseases can infect humans as well. For each pet at each visit, we do a complete exam. Along with their medical history, we determine the best vaccination protocol for them. For animals with serious vaccine reactions, or those that have other medical problems, we may adjust the protocol or even consider checking their antibody levels (titers) to help determine if vaccination is necessary. Although titer testing has historically only been available at specialized laboratories, we can now check some of these antibody levels in-clinic after a simple blood draw.

Serious side effects to getting vaccinated are extremely rare. Most commonly we see mild lethargy, low-grade fever and soreness at the injection site.  If your pet is due for an exam and vaccinations, or if you have any questions regarding vaccination or titer testing, please call us at (902) 893-2341!

Here are some great resources for you to check out:

https://www.aaha.org/public_documents/professional/guidelines/caninevaccineguidelines.pdf

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=524