Frequently Asked Questions

Every 3-4 weeks until 19-20 weeks of age

Dogs are den animals and instinctually do not tend to eliminate in their own space. Confinement is imperative for setting your puppy up for success with house and chew toy training. Confinement can teach your puppy to eliminate in the desired environment, settle, and chew the appropriate toys. If a puppy is left unsupervised inside, it will soil in the home and chew inappropriate items. It is much easier to prevent unwanted behavior than rehabilitate it once established. Before confining your puppy to his doggie den, you first need to teach her to love her crate and confinement. This is often easily done by stuffing a hollow chew toy like a KONG with kibble and the occasional treat. Let the puppy have these yummy treats only in his den. This technique works especially well if your puppy is not fed kibble from a bowl but only from chew toys or by hand as lures and rewards for training. Dr. Ian Dunbar explains this in great detail in his book: Before & After Getting your Puppy. The Positive Approach to Raising a Happy, Healthy & Well-Behaved Dog.

Mom’s antibodies from nursing and the placenta can interfere with a puppies and kittens immune response to vaccines until they are approximately 16 to 20 weeks of age. Because we don’t know when “mom’s” antibodies will regress, and your pet will generate his or her own appropriate immune response, we need to vaccinate in accordance with population averages. Most dogs/cats will see this immunity diminish after 16-20 weeks of age, which is why the last vaccination is given at this time.

Lepto. or Leptospirosis is a bacteria that lives in the environment. It thrives readily in moist soils and free standing water. Lepto. has many manifestations, but in its most severe form can cause severe illness or even be fatal. Generally, the bacteria results in significant liver and kidney injury. Lepto. is also zoonotic, which means animals can pass it to people. This is done easily as Lepto. is readily shed in the urine and absorbed across damaged skin or mucous membranes. Any dog who goes outside should optimally be vaccinated. Older vaccines have been theorized to result in a high rate of vaccine reactions. New vaccine technology has evened the playing field, making it as safe as any other vaccination.

The above vaccines are generally recommended for social dogs i.e. those who attend daycare, frequent dog parks, go to the groomer, etc. We do generally recommend at least an initial Kennel Cough or Bordetella vaccine in the juvenile months as Kennel Cough in puppies often results in pneumonia.

Obviously, we don’t want you to administer anything that makes you uncomfortable, but the diseases inflicted by these parasites are far worse than the preventative themselves. Plus, most preventatives are non-toxic to mammals. While every medication has side effects, the vast majority of pets tolerate these products with no ill effects.

The FDA has uncovered a small seizure risk associated with drugs from the isoxazoline class. It is not clear whether the pets who seizure were likely to do so anyway (as seizures are a fairly common problem in the dog), and the medication unmasks this, or the medication itself causes seizures. Suffice it to say, we see it rarely, and the cases we have identified tend to do well once the medication is stopped. At this time the Doctors at MAH and veterinary experts agree that the risk of flea/tick borne diseases is much more serious and more likely than seizures in an otherwise normal pet.

We consider this a normal variant. True reactions are characterized by one or more of the following: profound lethargy, vomiting, diarrhea, facial swelling, hives and possibly, a change in breathing. The former necessitates emergent evaluation by a veterinarian.

The science is complicated. Cats should be tested as soon as possible after they are acquired, following exposure to an infected cat or a cat of unknown infection status, prior to vaccination for FELV, and whenever clinical illness occurs. Since it can take 30-60 days after exposure for an infected pet to test positive and since there can sometimes be maternal antibody interference, a cat may need repeated testing to ascertain true retroviral status.

After an initial heat, a dog and cat’s risk of mammary cancer increases significantly. The difference is that feline mammary tumors are almost always malignant while canine mammary tumors are split down the middle (50:50).

In dogs there are certain breeds and situations we may recommend later spay or neuter your veterinarian will discuss this during your puppy visits to help you make the best decision for your family. In general, we are currently still recommending the spaying at 5-6 months for the majority of pets we see.

There are many reasons why a veterinarian may suggest delaying or even withholding an alteration:

• The pet is a large breed male dog, and achieving full growth/stature is more likely if he is neutered at 15-18 months of age
• The pet is a female dog with a deeply recessed vulva and allowing her to undergo on heat cycle will enable her vulva to “drop” thus reducing her risk of infection later in life
• The pet is a Golden or Labrador Retriever, and studies have demonstrated that keeping these breeds intact may prevent the risk of certain types of cancer
• The pet has brachycephalic airway syndrome and allowing him/her to mature to 1 year of age may enable us to determine if concurrent surgical airway correction is warranted

A male dog is still considered intact with an undescended testicle, which means he can mate and develop all the behavioral/health concerns we discuss in male intact dogs (roaming, aggression, marking, testicle cancer, prostatic infection). In addition, undescended testicles are more prone to becoming cancerous.

Yes, but per the American Heartworm Society, your pet should be tested 6 months later based on the lifecycle of the heartworm. Please notify us if compliance is an issue. We do offer a 12 month injection that may make life simpler for the busy or forgetful owner (Proheart 12).

Read more about heartworm disease here: www.heartwormsociety.org/pet-owner-resources

Only 10-15% of dogs with tick-borne disease will ever be “clinical” so rather than overtreating with antibiotics (which are not always benign), we suggest monitoring the pet for outward clinical signs and assessing a first morning urinalysis for protein (this could suggest a subclinical manifestation of disease attacking the kidney’s filters).

Medford Animal Hospital recommends specific flea and tick products based on their labels, convenience and efficacy. We generally steer clients away from topical flea and preventatives with the exception of Bravecto, Revolution and K9 Advantix II (dogs only). Unfortunately, even with these products and the oral ones, Ehrlichia is very difficult to prevent. This comes down to the rapid transfer of the bacteria from the tick. If your goal is to prevent tick attachment, you may want to consider K9 Advantix II or the Seresto Collar for your dog and the Seresto Collar for your cat.

Anal glands are scent glands, small pouches located on either side of the anus that house a variable amount of material designed to lubricate the feces during the defecation process and allow the dog another way to mark his territory or leave a sent signal for dog to dog communication. Many dogs/cats do not naturally empty they anal glands well, resulting in anal gland impaction. While scooting can signify this, scooting can also be seen with inflammation/infection of the anal sacs, an itchy rear end (common in allergic dogs), and/or per-vulvar skin disease (common in allergic females or those with a “hooded” vulva). Pets who are scooting frequently should be seen by a veterinarian.

Nail trimming 101:

• Positive reinforcement with handling of the feet (in the absence of trimming nails) is crucial. This should be started at a young age. Using high value treats and distractions can help to avoid pets being averse to nail trimming.
• If the nails are clear, trim in front of the pink “quick” to avoid bleeding and pain
• If the nails are black, the quick tends to end where two white lines to a point on the underside of the nail
• A “less is more” approach to restraint at home is best as long no one is at risk of getting hurt (pets can bite when fearful)
• Consider teaching your pet to use a scratching board instead
• Some pets are nervous enough to require sedation at home
• Some pets are nervous enough to require professional assistance or even sedation in a hospital setting
• Overlong nails tend to break, grow into the paw pads, alter mobility, etc.
• We offer nail trims at all appointment types and with technicians

Veterinary insurance is all privatized at this time, and Medford Animal Hospital has no specific affiliations. There are companies that offer wellness plans, catastrophic coverage or a combination thereof. Most coverage applies after a certain annual deductible is met and may include certain services or a total percentage of the overall cost. We encourage our clients to research different options and find the plans that best suit their needs. Minimally, we recommend catastrophic coverage as the cost of emergency and referral care can be burdensome. Enrollment can typically be achieved via phone or online.

The pet food industry is as confusing to veterinarians as it is to owners, but we try to keep out recommendations basic. Advertisers and pet store attendants may not be qualified to give you advice. Veterinarians make their suggestions based on the following standards: 1) the company manufactures AAFCO approved diets 2) the company’s focus is the advancement of animal well-being through research and quality control 3) the company has been subject to a minimal number of recalls 4) the company provides excellent customer service. Based on new research from the FDA, grain-free diets are NOT recommended unless otherwise approved by a veterinarian (there has been an association with cardiomyopathies in dogs).

Veterinarians from our practice tend to steer clients toward the following brands: Royal Canin, Purina (the Proplan line is the most extensively studied), and Hill’s Science Diet

Unfortunately, it’s really easy for pets to sustain nutritional deficiencies if they are not fed a commercial diet. Home cooking is also a common cause of obesity in pets. If you feel strongly about home cooking, we advise you consult with a board certified veterinary nutritionist or visit the website balanceit.com to create a custom diet using the appropriate supplement.

We don’t generally recommend doing this for many reasons: rich table foods can lead to stomach upset, even pancreatitis. At the very least, this practice is commonly affiliated with obesity. If this is a problem in your household, consider the following:

1. Adding a small amount of canned food to the diet
2. transitioning to a new kibble altogether
3. coating the kibble in a small volume of low or no sodium chicken broth, plain applesauce, cottage cheese (if tolerated), part-skim mozzarella cheese, boneless skinless chicken breast (cooked), or another suggestion offered by your veterinarian.

Not to worry! Anesthesia and sedation slow the gut. This is 100% normal and should likely resolve within the next 24-48h. If you haven’t seen a bowel movement by day 5, give the office a call. Constipation is generally accompanied by systemic signs of illness and unproductive straining.

Other than being really gross, this is generally not a huge problem. However, if your dog likes to snatch dog or animal feces in unfamiliar terrain, he/she may be at risk for certain infectious diseases. In a vaccinated dog, the most common of these is intestinal parasites. A dog on broad-spectrum parasite control (in a monthly heartworm preventative) is generally going to be well protected. That said, if this is a common occurrence, it may be a good idea to screen a fecal quarterly. Prevention is key 1) consider adding an over-the-counter product to his meals like Forbid; 2) consider adding several small pieces of pineapple to his meals; 3) consider mixing a small volume of meat tenderizer into his meals (sodium-free) 4) leash walk him only, equipping him with a harness than provides maximal control (harnesses that attached in the front of the chest are best for this). Occasionally, dogs are driven to eat feces as the consequence of one or more nutritional deficiencies. Please discuss this possibility with your veterinarian.

Weight loss is most easily achieved by foregoing treats and table scraps; however, over-feeding kibble and/or canned food is a common problem as well. Often, the instructions on dog/cat food bags overestimate a pet’s needs. Like us, every pet is different, with a different appetite, energy expenditures and metabolic rate. Adult cats rarely need to eat more than 250kcal/day. Dogs will obviously vary, but if your pet needs to lose, start by eliminating any canned food (assuming this is a small proportion of the overall diet). If further reduction is needed, his or her kibble can be reduced by 20%. From here, your veterinarian can calculate calories based on ideal body weight or recommend a prescription weight loss regimen. Lastly, obesity in spite of aggressive efforts to cut back may be linked with endocrine diseases, in which case your veterinarian may recommend blood work to investigate for hypothyroidism or Cushing’s Disease. Lean body condition is imperative as it is linked to overall health and longevity. Obesity in dogs is hugely problematic for their joint and spinal health while obesity in cats is routinely linked to diabetes.

Periodontal disease is characterized by inflammation of the periodontal ligament. This structure holds the tooth root in the pocket that houses each individual tooth. When bacteria forms on the teeth and gums, the immune system sends white blood cells locally in response. The result is disease of this ligament and weakening of the tooth root. Concurrently, bacteria migrate up to the root, resulting in abscess formation. Once more advanced periodontal disease has set in (this doesn’t take long to occur, especially in small breed dogs), brushing is minimally effective. Home care is strongly recommended, of course, but is most effective in young dogs or after an anesthetized cleaning. That said, not all dental products are alike, so please ask us what we recommend. You can’t go wrong with the vohc.org website. Regarding the anesthesia itself, your veterinarian feels deeply responsible for the health and well-being of your pet and would not recommend a dental cleaning if she did not feel it was in his best interest. Prior to any anesthetic event, you will be fully educated about the process and the risks.

Routine surgeries performed:

• Spay
• Neuter
• Dental prophylaxis and extractions
• Mass removal (Dr. discretion)

Other surgeries may be arranged depending on a number of factors:

• Prophylactic gastropexy
• Scrotal ablation with neuter
• Gastrotomy
• Enterotomy
• Enucleation
• Cystotomy
• Vulvoplasty

Developed and Emailed by the veterinarian performing the pre-surgical consultation

• Strongly recommended, possibly mandated in some cases (age and concurrent disease are major considerations)
• Can be performed during pre-surgical consultation
• Can be performed at a separate visit with technician
• Should be arranged at least one week prior to procedure
• Not applicable if > 3 months old

• Performed by a surgical coordinator (SC) Renee Mackunis
• Contact the office during normal business hours to leave a message for the SC

• Medications for nausea, pain and/or anxiety recommended the night prior or morning of surgery
• Lessen anesthetic drugs required to achieve a good plane of sedation
• Improve post-operative recovery
• Dispensed by Dr. performing pre-surgical consultation or SC

• Pick up food and water the evening prior to surgery no later than 10 p.m.
• Incidental eating/drinking after this time warrants a call to the hospital for advice

• A drop off time will be specific by the SC and reiterated by the client service representative confirming your surgery the night prior
• Arrive by this time and allocate at least 20m for the check-in process
• Expect discussion of our consent form and review of the procedure and risks by the doctor

• A combination of injectable and inhaled medications administered with an intravenous catheter and endotracheal tube
• Accompanied in most cases with intravenous fluid therapy to support water losses and blood pressure
• Monitored by at least one certified or highly experienced technician
  • Parameters routinely evaluated: heart rate, respiratory rate, blood pressure, pulse oximetry (a measurement of the oxygen saturation of red blood cells), capnography (a measurement of exhaled carbon dioxide)
• Common anesthetic complications routinely and easily managed: low and high heart rate, second degree atrioventricular block (an abnormal heart rhythm/arrhythmia induced by high vagal tone), low and high respiratory rate, low body temperament, low and high blood pressure
• Uncommon anesthetic complications: low blood pressure unresponsive to changes in fluid rate or anesthetic drugs, arrhythmia(s) unresponsive to anti-arrhythmic medications, critical changes in oxygen and carbon dioxide, aspiration pneumonia, respiratory arrest, cardiac arrest

1. Spay
   • Mid-abdominal incision, variable in length (length is not consequential as incisions heal side to side); removal of ovaries and uterus with ligation of vascular structures and uterine body near cervix; closure of body wall in multiple layers with suture
   • Possible complications: bleeding, infection (typically incisional), pain, dehiscence (suture failure/incisional opening), suture reaction, incidental bowel or bladder trauma (rare), incidental ligation of a urinary structure (rare)
   
   
2. Neuter
   • Dogs: Pre-scrotal incision (incision in front of the scrotum), 2-4cm on average; removal of each testicle through this incision via ligation of spermatic cord (vascular, neurologic and urinary bundle); closure of skin in single layer with suture and tissue glue
   • Cats: Scrotal incision, 1cm on average over each testicle; removal through incisions; ligation of the spermatic cord; no closure
   • Possible complications: bleeding, infection (typically incisional), scrotal hematoma (swelling due to the collection of blood, often from superficial skin bleeding), suture reaction, pain, dehiscence (suture failure/incisional opening)
   
   
3. Dental prophylaxis and extractions or Comprehensive Oral Assessment under Anesthesia (COHAT)
   • The procedure consists of the following:
     • A thorough dental exam to evaluate for the following:
       • Possibly infected teeth
       • Mobile teeth
       • Broken teeth
       • Resorbing teeth
       • Gingival inflammation/ulceration
       • Gingival growth
       • Boney or gingival masses
     • Dental x-rays to evaluate the underlying tooth roots and jaw bone
     • Ultrasonic scaling to remove tartar
     • Polishing
     • Local anesthesia (dental blocks) prior to any extractions
     • Surgical extraction of indicated teeth (this is based on dental exam and x-ray findings)
   • Possible complications: bleeding, pain, dehiscence, oronasal fistula (opening between oral cavity and nasal cavity), retained roots leading to recurrent/chronic infection, nerve damage (rare)

*Most surgical complications are minor and easily resolved with medication and supportive care*

• After surgery, your veterinarian will contact you to discuss the procedure and arrange a discharge time
• Your discharging technician will describe any medications, E-collar use, monitoring and instructions for rest/home care
  • Typical medications
    • Non-steroidal anti-inflammatory drugs for inflammation and pain (Rimadyl for dogs, Onsior for cats)
    • Gabapentin for pain
    • Buprenorphine for pain (cats)
    • Sedatives (Trazodone) to facilitate rest
    • Antibiotics (dispensed on a case by case basis)
  • E-collar use
    • A necessary evil to prevent self-trauma
    • To fit correctly, the edges of the collar must extend at least 2 inches past the tip of a pet’s nose in spite of backward movement with the skin around the neck
    • Pets are aggravated by these and may behave differently upon their application; rarely, however, do these changes warrant stopping their use
      • If eating is an issue, the “cone” may be removed for a few minutes but feeding time must be closely supervised
    • Certain approved devices or bodysuits can be used in their place but must be evaluated by your veterinarian
    • Failure to use an E-collar can result in severe incisional trauma, infection, even dehiscence (opening of the incision); in some instances that self-trauma can necessitate a second surgery
  • Rest
    • No running, jumping, playing or use of stairs for 7-10 days
    • Gradual reintroduction of exercise after suture removal over 5-7 days
    • Crate, gait or restrict to small area/room when unsupervised
  • Feeding
    • Most post-surgical patients can eat their typical diets; post-operative dentals with extractions should have any kibble soaked in water for 20m before it is offered
  • Monitoring
    • Appetite, water intake, urination, bowel movements, energy level
    • Report any severe lethargy, pale mucous membranes, abdominal distension, vomiting, frequent voluminous diarrhea with or without blood or any symptoms of concern
    • Incision site: report redness, swelling, discharge, pain or dehiscence immediately

• Some changes in behavior are normal and expected after anesthesia and even routine surgical procedures; a spay, for example, is a major abdominal surgery; the following are acceptable for the durations indicated though your veterinarian should be made aware of these signs:
  • 24 to 36h of mild sedation/lethargy
  • Inappetence for up to 24h
  • Decreased water intake for up to 24h; the intravenous fluids administered often more than hydrate a pet undergoing surgery thus stifling his/her drive to drink
  • MILD oral or nasal bleeding in post-operative dental extraction patients
  • Slightly soft or delayed bowel movements
    • Anesthesia results in physiologic stress and can alter blood flow to the gut, resulting in softening of the stools
    • Anesthesia slows GI motility; with this and a fast, it is not abnormal for bowel movements to occur 3 or even 4 days post operatively
• Troubleshooting
  • For inappetence, offer a bland diet of boneless skinless chicken breast and white rice; 50:50 proportions and small frequent meals work best; for protracted inappetence (>24h) a call or a recheck is warranted;
  • Cats should always be fed a commercial diet due to their unique nutritional needs; if appetite is an issue, please contact the office immediately
  • Please note that Rimadyl or any NSAID must always be given with food to avoid further GI upset; if a pet is not eating, he/she should not receive this medication; in the absence of other pain medication, pain could be debilitating for a pet, and the office should be contacted to resolve this; this is particularly problematic for post-operative dental patients who may not be eating because of pain
  • For concerns re: hydration, add no sodium chicken broth to kibble or consider a GI-friendly canned diet (our office can prescribe this); if water consumption does not occur within 24h of surgery, contact the office no later than day 2 after surgery
  • Force feeding veterinary patients is not recommended as they develop food aversions rapidly
  • If food is offered, and the pet immediately appears disinterested or even repulsed, remove this immediately and try again in several hours
  • For soft bowel movements, use the bland diet above or simply add rice to the pet’s present diet; you may also contact the office for a probiotic; we don’t recommend the use of over-the-counter recommendations like Pepto Bismol or Imodium; diarrhea (any bowel movements more notable an infrequent soft stool) should be reported immediately
  • For delayed bowel movements, do nothing. Unless active straining with little to no fecal material is seen, constipation is unlikely. Refeeding with small frequent meals may help restore normal motility. If a bowel movement has not been seen by day 4-5 after surgery, call the office.

• All owners of surgery patients should be contacted the day after their procedures; please be available to give an update
• All soft tissue and oral surgery patients are rechecked at no charge brief exam 10-14 days after their procedures, whether or not sutures need to be removed
• Often, suture removal is not necessary because any surgical knots are “buried” under the skin and we often use absorbable suture that the body is able to break down and “absorb”
• This is an opportunity for your veterinarian to ensure the incision site(s) are healing appropriately, and the pet is doing well
• Recommendations for exercise, bathing, swimming and grooming can also be given at this time
• As many of our spays and neuters are performed in pets ~6 months of age, this also give us an opportunity to talk about the long term plan with diet
• For dental procedures, recommendations for dental home care are made