Myths about spaying and neutering your pet

Pet overpopulation has reached heartbreaking proportions in this country.  Millions of puppies and kittens born in this country are put to death because there are simply not enough homes available for them all.  56% of all dogs and 75% of cats at animal shelters will be euthanized, and this figure doesn’t take into account additional animals born feral (wild), abandoned by the side of the road or in the wilderness, or killed by traffic, predators, starvation and disease.  Consider the statistics of how just one unaltered female dog or cat can result in thousands of unwanted puppies or kittens:

One intact female cat produces three litters per year with an average of four kittens per litter, half of which are females.  Within six months, the female offspring are also reproductively mature and begin producing litters of their own.  By the end of the second year, 144 kittens have been born.  By the end of the third year, 1,728 kittens and by the end of the fourth year, a whopping 10,736 kittens have been produced.

A female dog on average produces one litter per year of four or more puppies per litter.  The female puppies reach sexual maturity by the age of eight months and also begin producing puppies.  By the end of the second year, twelve puppies have been born; 36 puppies by the end of the third year, and 324 puppies are looking for homes by the end of the fifth year.

I often hear clients telling me that they don’t want to spay or neuter because their dog is a purebred and they can make some extra income by breeding and selling the puppies.  This rarely turns out to be true.  One out of four dogs in the shelter is a purebred and many breed rescues exist with an extensive list of purebred dogs looking for homes.  Although there are people who sell ‘designer’ puppies (or breeds temporarily made popular in movies or by celebrities) until the passing trend fades (then leaving a glut of puppies without homes), most backyard breeders are lucky to make back their expenses for the time and effort invested by the time they wave goodbye to the last puppy—if indeed they are able to find homes for them all.  Of my clients who bred their dogs in hopes of profit, none have wanted to repeat the project.  Even if you ‘know’ you will find willing homes for every puppy you produce, keep in mind that there are now that many fewer homes available for an equally deserving puppy at the shelter.

A few clients have discussed breeding their dogs in expectation of “getting another one just like him/her”.  However, genetics are a funny thing, even in purebreds and more so in mixed breeds.   Very rarely will offspring result as expected, even when produced by expert breeders.

Another myth is that “it’s best to let females have one heat cycle, or even one litter before spaying”.  Not true!  Disease prevention is one of the great advantages to having your pet altered prior to sexual maturity.   In females, not only does spaying prevent unwanted pregnancy, it also eliminates the risk of a life-threatening uterine infection called pyometra, and risk of mammary gland carcinoma (the canine version of malignant breast cancer).  For males, there is a decrease in prostate problems, prevention of testicular cancer, and foul ‘tomcat’ odors.  Behavior improvement is another advantage to having your pet altered as well.  For those concerned about property protection, neutered pets are every bit as protective of their “pack” as intact animals, but are also less likely to jump over or dig under fences, start fights with other males and mark territory by lifting a leg on the furniture.

Owners sometimes tell me they want their children to experience the miracle of birth.  Education about life is a great idea—but most animals prefer to creep off into dark corners, usually in the wee hours of the night, not be the center of attention and certainly not on cue.  YouTube has literally thousands of videos of animals giving birth for you to share with your family.  At the same time, this is a great opportunity to explain about pet overpopulation and how kindness and responsibility towards animals is a valuable lesson as well.

Clients occasionally tell me that they would never want to unnaturally deprive their pet of its sexuality.  However, for animals, sexuality is just a hormonal drive to reproduce their species, not part of their personal identity.  They don’t invest emotionally or maintain permanent relationships with their offspring, don’t look forward to family weddings, grandkids or high school graduations.  Keeping sexually intact animals is not only an invitation for accidental unwanted pregnancy, but also keeps both males and females in a perpetual state of sexual frustration that’s unpleasant for everyone, including the pet.

So what exactly is involved in spaying or neutering?  Spaying involves the surgical removal of the ovaries and uterus in females.  Neutering is the surgical removal of the testicles in males.  Since both procedures require general anesthesia, a blood test is performed prior to surgery to provide valuable information about your pet’s internal organ health and function.  All of our surgical patients receive an injection for pain as well as medications for home administration to keep them safe and comfortable.  Most pets are dropped off at the hospital in the morning (or the night before if more convenient), undergo surgery and rest under observation for a few hours before going home in the afternoon or evening.  Once home, pets will generally be sleepy that evening as an effect of the pain injection, but are usually back to their normal selves by the next day.

Please contact our office for any other information or questions that you may have.

why anesthesia-free dentistry is no dentistry at all

In my neighborhood, there are grooming parlors and feed stores that now advertise “anesthesia-free dental grooming” utilizing a free-range self-professed hygienist.  I admit, other than abuse and puppy mills, there are few animal-related subjects more likely to get me all worked up than “non-professional dental cleaning” as the American Veterinary Dental
College calls it.  Let me explain why.

It’s not difficult to determine if a veterinarian holds the professional credentials needed to practice veterinary medicine, but there is no certification or formal training required whatsoever to call yourself a dog dental hygienist.  You just need a business card and a few hand tools, but there is a lot more to appropriate dental care than just chipping
off the obvious tartar.  A thorough oral exam also involves evaluation of periodontal pockets, cracked or fractured
teeth, cavities, dead pulp, oral infections or the presence of oral tumors.  These are not skills casually picked
up from a weekend course or buying a book.  After all, there are also books that explain how to perform abdominal
surgery on your dog.  Reading one doesn’t make you qualified to actually do so, nor give you the resources to recognize
or clean up any resulting train wrecks.

Case in point, not long ago I saw a nice little poodle (a breed notorious for denta ldisease) whose teeth had been scaled by a  dental groomer” on a monthly basis for the previous year or two.  The groomer finally advised the owner to bring Calvin in to a veterinarian for an examination and treatment because numerous teeth were loose or falling out,
with the comment that it was “better the teeth fall out because then the underlying infection isn’t trapped”.  What
a nightmare—how about we treat the teeth properly in the first place so there isn’t any infection underneath?  This poor little guy had lost so much bone integrity due to the chronic infection that his jaws had all the strength and
density of a potato chip.  He was unable to eat anything other than soft food and still had sewer-breath despite the
shiny white (though rotten) teeth.  Happily, after professional dentistry (and extraction of over a dozen abscessed
and painful teeth), he recovered well and once again began eagerly playing with chew toys and eating kibble he had refused for the previous year because of oral pain.

I have heard comments to the effect of, “You’re a vet and you don’t like the competition, so of course you want to advocate expensive anesthesia dentals.”  Actually, my profit margin would be considerably higher if I didn’t have to use professional (but very expensive) equipment for examination, cleaning, anesthesia, monitoring and training.  Don’t I wish that every procedure I perform could be done with a few hand tools, a weekend course and “Helga the Enforcer”
holding the animal down.  Unfortunately, it just doesn’t work that way.

Let’s talk about the need for anesthesia.  In brochures and advertising, scare tactic phrasing is used along the lines of
“why would you put your pet at risk of death or injury from toxic anesthesia?” (this is a verbatim quote) implying that a responsible owner would never placetheir beloved pet in such terrible danger. I’m not saying that anesthesia is 100% risk-free (you can read my blog about anesthesia here), nor do I advocate its use unless justified, but modern anesthesia, vital sign
monitoring and patient evaluation techniques minimize the risks.  Millions of anesthesia procedures are safely
performed annually in veterinary hospitals.

So entirely aside from the anesthesia aspect, does a non-professional dental cleaning even deliver a quality service?
On the surface, it would look like this is the case, but again, no, andhere’s why:  Just like an iceberg, most of the tooth is below the surface of the gums. This subgingival pocket is where bacteria and periodontal disease is most active, causing extensive damage by eroding the periodontal ligament holding the tooth in place.  Even though the visible tartar forms on the exposed portion of the tooth, it’s underneath the surface that bacteria causes abscess, pain, infection and damage to the tooth root and surrounding bone tissue.  Simply scaling off the exposed tartar is a cosmetic procedure that makes the tooth look better, but does little or nothing towards actually improving the health of the teeth where it counts.  You might as well be applying
white paint to cover up the tartar for all the good it does.

An additional issue is how scaling itself affects the teeth.  It’s simply the nature of the beast that scaling creates microscopic scratches both on the exposed tooth crown and underneath in the subgingival pockets.  Any form of scaling in a conscious animal is ineffective at adequately reaching all the areas underneath the gumline.  It takes time and patience and while it is
does not cause damage, it isn’t comfortable for the animal, even less so in the presence of advanced periodontal disease.
Furthermore, a really thorough job requires the use of an ultrasonic scaler, not hand tools (dental groomers by law cannot use mechanized tools,although some do illegally).  Animal teeth are like humans, in that they have a live nerve that very efficiently transmits sensation, including pain.  While the ultrasonic scaler is extremely effective at cleaning teeth, even touching it to the tooth of an awake patient is very uncomfortable, very similar to what I would imagine biting down on a live electrical wire would be like.  Don’t ask me how I know this.  Let’s call it misguided curiosity and leave it at that, except to mention that my staff had to peel me off the ceiling.

In humans, because we understand the reasons for discomfort, we can tolerate superficial dental cleaning without general anesthesia. Most dental offices will use local anesthetics to numb the dental arcades for deep cleaning, or even general anesthesia for extensive procedures.  Animals don’t understand why they are there and simply do not tolerate the discomfort or restraint needed to do an effective job without anesthetic.  If the discomfort to the animal during non-anesthesia scaling is negligible or non-existent, then the cleaning was inadequate.  Yes, I have watched the YouTube videos and not once have I seen the “dental grooming” procedure performed even close to professional veterinary standards.  If the cleaning is thorough and effective at reaching into the subgingival pockets, then it’s simply too uncomfortable for even the most stoic of fully awake animals to tolerate.  There is no middle ground, nor would I consider it very compassionate or pet-friendly to
the animal to even ask them to tolerate such restraint and discomfort simply to avoid anesthesia.

The last step of any effective dental cleaning is polishing the teeth, which sounds like a cosmetic procedure, but isn’t.
Polishing removes the microscopic scratches left on the tooth after scaling and also requires time and patience to get into all the awkward little spaces and angles.  Failing to polish the dentition leaves a foothold for bacteria to adhere to, which then leads to reformation of tartar even more rapidly afterwards.  On many occasions, I have seen advanced periodontal disease in pets after repeated bouts of “dental grooming” whose owners mistakenly thought they were improving the dental health of their animals by enlisting such services.  In fact, the cosmetic-only cleaning was contributing significantly to the problem
rather than solving it.

Finally,any dental procedure (and even the pre-existing periodontal disease) releases a shower of bacteria into the bloodstream, potentially causing damage to kidneys, heart and other major organ systems if left unchecked.  Antibiotics are an absolutely critical part of professional care, which cannot be provided by a non-veterinarian.

Here is what I tell my clients–they can improve their dog’s dental health to a large extent by daily brushing, which I show them how to do properly, and with oral gels, dental chews and sometimes a dental diet.  I would far rather they perform regular at-home care and wait until a full professional examination and cleaning is justified, rather than place their pet at risk of further damage and ultimately higher cost resulting from non-professional dental groomer.

More information about this topic and others pertaining to veterinary dental issues can
be found here:

http://toothvet.ca/Old%20CUSP%20Articles.htm

http://www.avdc.org/ownersinfo.html

Susan Garlinghouse, DVM

All Creatures
Animal Hospital

Montclair, California

www.allcreaturesanimalhealth.com

909-946-3211

Never trust a dog named Precious

When I was a student first applying to vet school, I had to write a lot of essays explaining why I deserved a seat more than the next eager, bright-eyed applicant.  Like everyone else, I enthusiastically described how I longed for the smells of a well-stocked barnyard, lived for all-night study sessions and really didn’t require much sleep or food that didn’t come from a vending machine.  I could not only survive being methodically stomped by cows in freezing weather but even enjoy the experience.  Many, many hours were spent assuring the admissions committee that I could handle more physical abuse, scorn, isolation from family and crushing student debt than anyone else on the planet outside a federally-mandated mental institution for the criminally insane.  Although all this occurred before the advent of YouTube, I suspect a quick video clip of me banging myself on the head with a ballpeen hammer just for fun could only have strengthened my application.

However, one skill I really should have cultivated early and maybe even auditioned for the dean of admissions was an ability to keep a straight and smiling face in front of clients no matter what.  The value in this skill is that, mysteriously, not all pet owners are amused if you point at their pet screaming hysterical laughter, reel back in horror gibbering, “By all that’s holy, what the hell is THAT?!” or ask them “has he always looked like that?” when they just came in for vaccines and a wellness exam.

I try hard not to judge a book by its cover, but sometimes it’s a challenge not assuming certain character traits and expectations of an animal based on the name.  Not because I’m going to offend an owner by informing them that their precious darling is less than the center of the doggy universe—in their eyes, he or she is just that and who am I to point out that Foofykins has all the compelling beauty and charm of a dead carp?  If you want to stay in business for more than a day and a half, you quickly cultivate a long list of diplomatic euphemisms to use in reference to the more unique pets encountered in practice.  “Different”, “quite the character”, “aren’t we special” and “fun” are all useful phrases even when the animal in question looks like the leftovers of a genetic experiment gone horribly awry or an escapee from a Stephen King novel.

The problem is that when you see that your next appointment is named Precious, Baby or Lovey, you naturally envision an irresistible little bundle of fluff that wants nothing more than to cuddle adoringly into your lap as you whisper all your hopes and dreams into his silky ears.  To my chagrin, I have discovered it is a mistake to do this and I have the scars and dry cleaning bills to prove it.  For unknown reasons, the odds are excellent that pets with such names have only recently been ejected from the bowels of hell by Satan himself for the express purpose of chewing my face off and then going after my family.

Let’s take Lovey as an example, a terrier mix whom (I discovered later) came to my practice after every other vet hospital in town had resorted to restraining orders, threats of litigation, law enforcement and tactical nukes, along with some hysterical whimpering to Please Just Go Away.  While I’d like to delude myself that Lovey’s owner was just demonstrating exceptional judgment in choosing my practice to patronize, I suspect I was just next on the hit list.

It’s probably worthwhile to point out that individual animals have different methods of avoiding an unpleasant experience.  Running away and hiding are useful strategies.  The more subtle felines invoke the Cat Cloaking Device and assume that if they refuse to look at you, you must not really be there.  Animals spoiling for a rumble will bark, hiss, glare at you sideways while quietly growling or, on one memorable occasion (also in a pet sweetly and inaccurately named Baby), immediately launch themselves shrieking at your throat without interim negotiations or warning.

Lovey was more creative in that all his defenses involved voiding internal contents as enthusiastically and copiously as possible.  Prior to this encounter, I hadn’t actually realized that dogs were capable of aiming fecal matter with such accuracy or range.  Clearly I had also underestimated by a factor of ten the sheer volume that could be instantaneously expelled at whim from the GI tract of this 20-pound demon spawn of Lucifer.   Nor did I recognize that exceptionally gifted animals can in fact defecate, urinate, void their anal glands and stomach contents all at the same time.  Who knew?

It is proof of God’s benevolence that not even Lovey was capable of spewing chunks of this magnitude exclusively in my direction, the result being that at least I was not the sole recipient of this largesse.  The bad news was that the aftermath was a Haz Mat crime scene that required all but a fire hose, flamethrowers, a skip-loader and an exorcist to resolve.  Keep in mind that the veterinary procedure that triggered this Festival of Feces was a toenail trim.  The owner later commented that eighteen dollars was a pretty stiff fee for a simple toenail trim, loftily ignoring the hapless cries of revulsion and dismay from my staff scraping down the mess in back.  As it happens, eighteen dollars was about half the cost for the pizza I provided as a shameless bribe to keep the staff from stampeding out the door before someone reported me to the Environmental Protection Agency.

Readers will excuse me if I was less than enthused to see a pit bull named Chomper next up on the appointment schedule.  I will admit that slipping quietly out the back door and taking up a life of crime and substance abuse crossed my mind.  But again, never judge a book by its cover.  As soon as I crept hesitantly into the next exam room, I was greeted by seventy pounds of squirming, grinning goofy knucklehead that wanted nothing more out of life than to get his belly scratched by the nice lady in the white coat.  I wish I could pretend that his enthusiastic snuffling was due to instant adoration, but I suspect it was just a fascination with the fermenting road-kill drippiness courtesy of Lovey.

Susan Garlinghouse, DVM
All Creatures Animal Hospital
Montclair, California
www.allcreaturesanimalhealth.com
909-946-3211

Understanding the risks of anesthesia

Whenever I recommend a surgical or dental procedure at All Creatures Animal Hospital, a lot of my clients worry that their pet will die under anesthesia.  Some of them can relate second- or third-hand horror stories of friends or family who lost a pet under anesthesia and thus has come to the conclusion that anesthesia is a terribly risky business that should be avoided whenever possible.  I agree, you don’t go around lightheartedly administering anesthetic drugs to any animal without a good reason.  It certainly didn’t do Michael Jackson any good.  However, anesthesia is all about risk management.  The analogy I like to tell my clients is that anesthesia is a lot like driving a car onto the freeway.  If you just shut your eyes, hit the accelerator and hope for the best, the odds are pretty good that eventually something very bad is going to happen to you.  On the other hand, if you pay attention, drive carefully and avoid oncoming hazards before they cause an accident, the odds are a lot better that you’re going to reach your destination without a problem.  Occasionally accidents still happen despite your best efforts, but usually not.

So just like driving on the freeway, the approach to anesthesia is not to avoid it entirely, but to proceed carefully, watch out for hazards and avoid them long before they cause a problem.  Whenever I hear about an animal that died under anesthesia, I don’t automatically assume that the anesthesia itself was necessarily the core issue.  The more likely scenario is that the pet’s vital signs weren’t being monitored closely enough.  By the time it came to someone’s attention that the animal’s heart rate, breathing or blood pressure was dropping too low, it was possibly too late to do anything substantial about it to reverse the imminent wreck.

The textbooks provide general guidelines about the correct drug dosages for different species and types of anesthesia, but just like humans, animals are individuals, too—what works for one pet might be not enough for another or way too much for a third.  The method by which we differentiate between individual responses is to carefully watch for changes in vital signs the entire time that animal is under the influence of those drugs.  At our hospital, every animal under anesthesia has monitoring equipment attached that continuously measures heart rate, blood pressure, breathing, temperature, oxygen saturation (how much oxygen is actually being carried through the blood) and the electrical activity of the heart, just the same as with a surgical suite in a human hospital.  I also assign a nurse whose sole responsibility is to watch those vital signs throughout the entire procedure and bring any changes to my attention immediately so that I can fix the problem before it becomes life-threatening.  Why don’t I just watch it myself, if I’m standing right there?  Presumably, I’m performing a surgical procedure and probably focused on what I’m doing.  If the animal’s heart rate starts doing something unusual, I want to know about it right away—not five or ten minutes later when I happen to glance over.  Back to the freeway scenario, if there’s a semi-truck running you down, you want to know about it while it’s still a mile away—not when it’s about to smack you into the next time zone.

How often does an animal respond differently to anesthesia than the textbooks say they should?  In my experience, about one animal in twenty needs something adjusted in their anesthesia—the isoflurane gas a little higher or lower, the addition of a drug to increase blood pressure, maybe an additional tranquilizer as the animal is waking up if they seem particularly anxious or disoriented.  I do maintain a “crash cart” of emergency drugs used to resuscitate an animal that has stopped breathing entirely or is otherwise really in trouble.  Most of those drugs I have to throw away unused once they reach their expiration date because I’ve never needed them.  I don’t need them because I watch for oncoming hazards and avoid them long before they have a chance to become a problem.

So when I talk to pet parents about surgery for their animals, whether at my place or elsewhere, I recommend they ask not just about the procedure itself, but ask specifically about vital sign monitoring under anesthesia.  Is there a technician monitoring anesthesia during the entire procedure, or is the vet trying to multi-task and do everything themselves?  Do they just check to see if the animal is still breathing, or do they use monitoring equipment that provides a visual display and sets off alarms if something starts to go wrong?  Do they install an IV catheter prior to every surgery, or do they just hope they’ll be able to find a vein during an emergency?  Do they place an entubation tube into the trachea so they can continue to breathe for the animal if they stop doing it on their own?  And if not—why not?  Usually, cutting corners with anesthesia is a cost-cutting measure so one vet can provide a procedure for less than the next hospital down the street.  Pet owners are shopping prices a lot more in this economy and don’t always realize they need to compare apples to apples, and anesthesia (or even surgery) at one facility may be much different than anesthesia at another place.  If one vet hospital doesn’t take every single opportunity to avoid that metaphorical truck about to run down the pet on the surgery table, just realize that a lot of the time, they probably can get away with it.  But sometimes they don’t.  For my money, I’m going to continue to take every last safety measure I can, so I don’t have to make that phone call, “I’m sorry, but your pet died under anesthesia”.

Susan Garlinghouse, DVM
All Creatures Animal Hospital
Montclair, California
www.allcreaturesanimalhealth.com
909-946-3211

Why I like “cheap” ACL surgery

A torn cranial cruciate ligament (also called a CCL or an ACL) is the most common orthopedic injury we see here at All Creatures Animal Hospital in medium and large size athletic dogs (and by “athletic,” I mean the goofy knuckleheads that leap around like grasshoppers and steeplechase over the furniture at high speed.)  Invariably, the dog starts limping right after a play session and when it doesn’t resolve in a few days, the owners call for an appointment.  It’s so common that vets call these a “parking lot diagnosis,” meaning we can just about diagnose the problem watching the dog walk across the parking lot before they even reach the door.

Once the ligament is partially or completely ruptured, it won’t heal again on its own, even if the dog is kept strictly confined, wears a brace and takes anti-inflammatory medications.  There’s just too much tension on the ligament and it’s like trying to repair a bungee cord while hanging off the end—it just won’t happen.

The treatment for the best long term outcome is surgically stabilizing the knee.  This can be done essentially one of two ways—one, surgically changing the geometry of the knee so that the downward forces putting tension on the damaged ligaments are neutralized.  These surgeries are the tibial tuberosity advancement (TTA) or the tibial plateau leveling osteotomy (TPLO).  In the So Cal region, these surgeries cost $3700 – $4500, and require a pretty difficult 6 – 8 week recovery period.  As the surgery is very invasive, these are painful procedures and require significant pain management and long-term confinement for the dog during recovery.

The other surgical option for torn ACLs is extracapsular stabilization (ES).  There are several techniques that are very similar in providing an artificial ligament outside the joint capsule of the knee to do the work that the torn ACL is no longer capable of performing.  The artificial ligament consists of a very strong synthetic material placed through small holes drilled through the bones above and below the knee, pulling them together and eventually becoming a permanent part of the knee as scar tissue forms over the top.  While not quite the same as the original equipment, the knee is highly functional, regardless of how big and active the dog may be.  I can say this with some authority as my own border collie, Chase, (an alumnus of the ES technique), gleefully hurtles through the hospital at Mach 3, leaping obstacles with a stuffed dragon crammed in her mouth.  I’m pretty confident there’s not much wrong with THAT knee, and she is definitely not a unique example.

While many surgeons advocate the TTA or TPLO procedures, I generally prefer ES for several reasons:  First, ES involves drilling small holes in the bone as opposed to actually cutting bone, and so is less invasive.  Less invasive means much less painful for the dog and a faster recovery.  Most ES dogs are toe-touching by the next day, as opposed to several weeks later with the more invasive procedures.  This makes post-surgery life much easier on both the dog and the owner.

Second, ES surgery is much less expensive for the owner—at my practice, I charge approximately $2100-$2400 for most dogs, which is an all-inclusive, out-the-door cost.  It seems counter-intuitive that a vet would recommend the less expensive procedure, but here’s why:  A torn ACL is often a bilateral issue—meaning that if one side needs surgery, the odds are pretty good that eventually the other side will, too.  The economy is tough for everyone and while some dog owners might be able to afford $4000 or more for the more expensive surgery once, trying to find another $4000 to do it all over again for the other knee is a tough job, and impossible for a lot of people right now.  Add to that the longer and more painful recovery for the TTA or TPLO and many owners just won’t or can’t do it.  I’d much rather provide a more economical procedure that still does the job, doesn’t require nearly as painful or prolonged recovery time, and increases the chances that if the opposite knee also eventually requires surgery, it will get repaired as well.

And third, while some surgeons have differing opinions, the ES technique just works.  I’m from the school of “if it ain’t broke, don’t fix it”.  Clearly, if the ACL is blown, it needs some fixing.  However, the really, really smart surgeons—the ones that write the textbooks and teach all the other surgeons—have demonstrated that all of these Big Three techniques have about the same 92% success rate.  So if all three procedures correct the problem to the same extent, then why would a veterinarian insist on using the technique that’s more expensive and harder on both the dog and owners?  It would be likely to assume many surgeons have a natural bias towards the technique they’re most familiar and comfortable with using.  My policy is to go with the surgery that is effective and also makes life as easy and painless as possible for both patient and client.  A happy dog means a happy owner and a happy veterinarian, and that’s a win-win all the way around.

Susan Garlinghouse, DVM
All Creatures Animal Hospital
Montclair, California
www.allcreaturesanimalhealth.com
909-946-3211