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Dog (Canine) Spay, Neuter, Vaccine Prices and Services

The following pages provide a description of the surgery options for spay and neuter of your pet. It also explains the procedures and recommendations for the health of your pet. Feel free to download these forms to help with the process of keeping your pet healthy.

Cat (Feline) Spay, Neuter, Vaccine Prices and Services

Health & Wellness – Dog and Cat

Bearded Dragons

Bearded Dragon Care

Birds

Chinchilla

Desert Tortoise

Guinea Pig

Iguana

Iguana Care

Rabbit

Rat and Mouse

______________________________________________________________________________________________________The Advantages of Neutering Your Male Pet

Many people choose not to neuter their male pet because they believe it takes away their “manhood” or makes their pet less masculine. Some people think that neutering can change their pet’s personality and may make them gain weight. While some people’s reasoning may be true, the benefits of neutering far outweigh the reasons for keeping your pet intact (not neutered). Below are listed the advantages of neutering. Please keep them in mind when deciding what is best for your pet’s health and well-being.

Advantages of Neutering Your Pet:

Neutering prevents cancer of the testicles and prostate
Birth control
Greatly decreased chance of prostate diseases
Neutering helps curb unwanted marking of territory
Decreased aggressive and territorial tendencies
Intact pets tend to frequently escape and roam to find mates

After your pet’s surgery, you will notice he will be sleepy, possibly for a few days, as the anesthesia wears off. Some pets prefer to be alone in a quiet, dark area to recuperate. This is completely normal and should be allowed.

You will be given pain medications for your pet to keep him comfortable. The doctor may send home additional medication for sedation, if necessary, if he is normally very active. It is important to keep him from jumping, playing and running around for about one week so that his incision may heal properly.

If you have any questions about what to expect with your pet’s neuter, please feel free to call. Our nurses would be more than happy to answer any questions you have. We at The Scottsdale Veterinary Clinic understand that pets are not just pets; they are beloved members of the family.

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The Advantages of Spaying Your Female Pet

Some people choose not to spay their female pet because their male pets are neutered or because there are no male animals around. Many people are simply concerned with the possibility of unwanted offspring, and are not aware of the medical risks involved in owning an un-spayed female. Also, too many people are unaware that smaller mammals, such as rabbits, rats, and guinea pigs have greater health risks when not spayed. Listed below are the advantages of spaying your pet. Please consider them while deciding what is in the best interest for the health and longevity of your loved one.

Advantages of Spaying Your Pet:

Spaying prevents uterine or ovarian cancers or infections. Uterine infections (pyometra) can easily cost $1000-3000 to treat.
Greatly decreased chance of mammary tumors and cancer
No unwanted offspring
No more messy heat periods or unwanted male attention

After your pet’s surgery, you will notice she will be sleepy, possibly for a few days.

Some pets prefer to be alone in a quiet, dark area to recuperate. This is completely normal and should be allowed. You will be given pain medications for your pet to make her more comfortable. The doctor may send home medication for sedation in case she is normally very active. It is important to keep her from jumping and running around for at least one week so that her incision may heal properly.

If you have any questions about what to expect with your pet’s spay surgery, please feel free to call. Our nurses would be more than happy to answer any questions you have. We at The Scottsdale Veterinary Clinic understand that pets are not just pets; they are beloved members of the family.

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Tips on Giving Your Pet Oral Medication

Cats:

When giving a medication in pill form first try wrapping it in deli meat, tuna fish or any treat your cat will enjoy. If that does not work, try the options below:
Capsules are easy to break open and sprinkle over wet food or tuna fish
Tablets: hide in wet food. Be sure to ask your veterinarian before crushing any medication. Some medications may become TOXIC when crushed.
If the above do not work you will have to force your cat to take the medication. Place the pill on the inside of the back corner of the mouth – as far back as you can get it. Then hold the mouth closed while they swallow. Dipping the tablet in a small amount of butter will help it slide down easier.
Liquid medications: you can sprinkle over food or tuna
If you free feed your cat you will need to give the liquid directly. Draw the medication up with the syringe/dropper provided. Insert the tip of the syringe in the pouch between the cheek and the teeth and slowly squirt the medication in while you cat swallows. If this does not work you can open the jaw by placing your fingers on each side of the jaw and pinching behind the canines. Once you have the mouth open slowly squirt the medication so as not to gag the cat but quickly enough they don’t have time to pull away. You can also hold the scruff and tilt the head back to squirt into the side of the mouth.

Dogs:

When giving a pill simply wrap it in any kind of human food or dog treat. Follow the medicated treat with a second, larger treat to encourage them to gobble up the first.
If for any reason this doesn’t work you can follow the above mentioned step for cats.
When giving liquid – let your dog smell it first then open the cheek pouch and slowly squirt it in while they swallow. Remember to hold the mouth closed until you see a good swallow – about 3-5 seconds. If you are having trouble you can open the mouth described above or try mixing it with wet food or chicken broth.
Foods such as marshmallows, liverwurst, peanut butter and other house hold foods work great for giving medications

We can flavor medications at The Scottsdale Veterinary Clinic with our FlavoRx system to make them more palatable. We are able to mix both pills and liquid into a variety of flavored liquids your pets will love including: MANDARIN ORANGE, CHOPPED LIVER, GRILLED TUNA, CRISPY BACON & MOM’S BANANA BREAD just to name a few.

Please call us if you are unsure what to give your pet. We are here to help!

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IF YOUR PET SHOWS ANY OF THE FOLLOWING SYMPTOMS TAKE YOUR PET TO A VETERINARIAN IMMEDIATELY:

Excessive Bleeding
Possible Ingestion of a Poisonous Substance
Possible Ingestion of Chocolate
Any animal that is NOT drinking water or eating
Smoke inhalation or burns from fire
Rabbit, Guinea Pig, or other rodent that hasn’t eaten in 6 hours or more
Neurologic Symptoms: Walking in circles, Seizures, Laying on the floor shaking
Vomiting or Diarrhea for more than 3 hours or constant vomiting or Diarrhea
Straining to or not urinating or defecating at all
Vomiting
Diarrhea
Lethargy
Limping
Constipated
Abnormal Behavior
Abnormal Urination
Discharge from wound or incision
Colored discharge from Eyes or Nose
Bleeding from Rectum or other Orifice

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DENTAL CARE RECOMMENDATIONS:

Dental care is EXTREMELY important for both you and your pet. It helps to prevent the need for frequent cleanings as well as health problems such as gingivitis, tooth decay, loss of teeth, and Kidney Failure associated with Dental Disease. Bacteria in the mouth and on the teeth easily migrate into the blood stream and can negatively affect your pet’s kidneys, heart, and liver.

Periodontal disease is PREVENTABLE with routine cleanings and routine preventative measures performed at home. Here are some ways you can help PREVENT Dental Disease in your pet:

Our first recommendation is starting your pet on OXYFRESH – it is an easier – less time –consuming method of preventing Tartar buildup and bad breath – In addition to preventing new tartar from forming – OXYFRESH bonds to tartar and breaks it off the teeth. Simply lift up their lips and spray it on the teeth every night until Tartar is gone – Than you can decrease to 2 – 3 times a week; Like most products – OXYFRESH is most effective if used daily – but using it a couple of times a week is better than none at all.
You can also treat your dog or cat to Dental Chews – For dogs – we recommend CET HEXTRA CHEWS – They have enzymes that are in toothpaste built into the chew as well as an antibacterial agent – Chlorhexidine Gluconate – These help to scrape tartar and plaque off the teeth and rid the mouth of bacteria – If you purchase chews from a local pet store – please keep in mind that they must be “enzymatic” to be effective – WE also carry CET CHEWS for cats in both poultry and fish flavor.
And lastly – but possibly the most important aspect to Dental Care – We recommend you try brushing your pet’s teeth at least three times a week – You can buy toothpaste and toothbrushes at The Scottsdale Veterinary Clinic or at a local pet store – We know it can be difficult to brush your pet’s teeth so here are a few ideas that may help you be more successful in performing this task:

Always put your pet someplace where they are NOT alone – such as a bathtub, table or counter
ALWAYS use a VERY soft bristled brush or finger brush – You can even start out by using your finger for the first few brushings to help your pet get used to the experience and the toothpaste
Do NOT use Human toothpaste – It contains Soap and Other ingredients that should NOT be swallowed – These ingredients could make your pet ill
Use pet toothpaste – We sell three flavors of the CET Toothpaste – or you may make your own toothpaste from equal parts of salt and baking soda – Simply place the “Toothpaste” on a wet toothbrush or soft cloth
Brush with a circular motion along the gum line and both the insides and outsides of their teeth
Be sure to feed your pet a special crunchy treat or dog food after brushing – Rewards for good behavior will help your pet understand that brushing is fun and should be done as often as possible
Try feeding dry crunchy food and treats – These will help to scrape plaque off the teeth
Every dog and cat are different and some are more prone to dental disease than others – Therefore periodic dental exams and regular cleanings are important to maintain your pet’s good health

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Tips for Feline Anxiety-Free Veterinary Visits

Preparing for your cat’s visit:

Take your cat’s carrier out and keep it in an area of your home where your cat spends the majority of his or her time. Do this at least 2 days prior to your schedule veterinary visit. This will allow your kitty to safely explore his or her kennel/carrier and become more comfortable and familiar with it before his appointment.
Purchase Feliway spray and spray inside of carrier and/or on bedding in carrier. Start spraying 2 days prior to your visit (recommend to spray carrier once or twice daily). Can also place smelly treats (seaweed flakes, catnip, etc) inside the carrier to coax your kitty to explore, and become comfortable with, the inside.
When getting ready for transport, keep your carrier covered (carrier covers can be purchased for this use, or you can use a light blanket, towel or sheet). This gives your cat a dark, quiet place. Also make sure that your kitty is safely secured in your vehicle. If you do NOT have a carrier, consider using a pillowcase or a cat sack to provide a dark, quiet transport.
Play relaxing, calm music during your drive. Classical, harp or nature sounds work best! This can help reduce unfamiliar and loud outside noises (cars, honking, etc.). Don’t play it too loud, or too soft. Too loud can be stressful, too soft won’t help drown outside noises.
If you have a very anxious or worried cat, consider purchasing a Thundershirt. Thundershirts are scientifically proven to reduce anxiety by providing your pet with a sense of security and safety, similar to swaddling an infant.
You may give us a call a day or two before your appointment and request to pick up anti-anxiety medication. For cats, our fear-free medication protocol consists of oral Gabapentin, as it is safe and usually effective. This can be given about 30 minutes prior to your scheduled appointment. A “Happy Shot” (injectable sedation) can be given during your appointment, if the oral therapy is ineffective for your kitty.
Bring Fluffy in HUNGRY! Treats are a wonderful way for our veterinary team to develop bonds and trust, distract during procedures and praise your cat for a job well done! Feel free to bring in your kitty’s favorite snack, or we can use some of our own! *Please make sure to inform your veterinary team of any food allergies your pet may have ahead of time!*
Do not put your carrier on the ground/floor when you arrive to your visit. Cats enjoy being up high. Keep their carrier on a counter, bench seat, table, etc.
Once you get into your exam room, open your cat’s carrier and leave the door open. Allow your cat some time to come out on his/her own prior to attempting to take them from the carrier yourself. Allow your cat to roam and explore their settings/surroundings.

Remember that animals have amazing senses, many that are much more developed than our own, and our dogs and cats can feed off of our energy as well. Keeping calm and stress-free during visits yourself will help your dog and cat to feel more secure and relaxed. If you are stressed-your pet will be stressed.

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Tips for Canine Anxiety-Free Veterinary Visits

Preparing for your dog’s visit:

Bring Fido in HUNGRY! Treats are a wonderful way for our veterinary team to develop bonds and trust, distract during procedures and praise your dog or puppy for a job well done! Feel free to bring in your dog’s favorite snack, or we can use some of our own! *Please make sure to inform your veterinary team of any food allergies your pet may have ahead of time!*
Just as with your kitties, it is shown that playing calming music (such as classical, harp or nature sounds) helps your dog to relax and also drowns out background noise.
If you have a very anxious or worried dog, consider purchasing a Thundershirt. Thundershirts are scientifically proven to reduce anxiety by providing your pet with a sense of security and safety, similar to swaddling an infant.
Always keep your dog on a leash, and close to you, when coming to the veterinary office. This provides control and safety between you and your dog. Remember– your dog may be friendly, but other dogs may not be!
Consider looking into a car diffuser in a calming scent such as lavender. This can benefit both you and your dog!
Consider purchasing and using a DAP (Adaptil) collar. Adaptil collars are activated by your dog’s body heat and releases calming pheromones constantly. *Keep in mind that this method typically requires at least 2-5 days after the start of wearing the collar to achieve desired effects.
You may give us a call a day or two before your appointment and request to pick up anti-anxiety medication. For dogs, our fear-free medication protocol consists of oral Alprazolam, as it is safe and usually effective. This can be given about 30 minutes prior to your scheduled appointment. A “Happy Shot” (injectable sedation) can be given during your appointment, if the oral therapy is ineffective for your dog.
If your dog has sound anxiety, consider looking into Mutt Muffs for sound reduction.
One of the best things you can do for your puppy or dog is to make them accustomed to walking on a leash and riding in a car.
- Practice putting the leash on and then taking it off, do this several times. If your dog wears a harness, allow them to wear the harness (supervised!) for a couple hours each day so it becomes familiar to them. You can practice leash walking them around your backyard until they become use to the leash.
- Daily walks are recommended not only for optimal health, but also for proper training and socialization! *ALWAYS make sure your puppy or dog is fully vaccinated and protected!*
- Ensure that their collar and/or harness are properly fitted and snug so that there is no risk of them slipping out of them and getting loose.
- Take your puppy or dog on car rides for many different reasons, not only to go to the veterinary office. Short car rides to the gas station, dog park, picking your kids up from school or other activities or even just quick rides around the neighborhood. This will help teach your dog that car rides can be fun and exciting and will reduce anxiety, stress and even motion sickness in the car.
- Make sure your dog is safely secured in your vehicle. This is not only safe for you, but also for your dog. Having a safe place for your dog to sit or lay in your vehicle will also offer them security.

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SPAY AND NEUTER PROCEDURES – CANINE

SAVE ON OUR SPAY AND NEUTER PACKAGES!

All surgery packages include Surgery Fee, IV Fluids, IV Catheter, Pre – Anesthetic Blood Profile,

and Post – Operative Pain Therapy. This is the best level of care recommended for your pet’s surgery.

Canine Neuter Package: Up To 70 lbs. $ 492.00

Canine Spay Package: Up To 70 lbs. $ 492.00

Canine Basic Spay: (Under 70 lbs) $282.02 – Includes pre-anesthetic exam, pain injection, pre- operative sedative, anesthesia, anesthetic monitoring, surgical drapes, pack, suture, Doctor’s surgical fee for OVH, hospitalization and recovery.

Canine Basic Neuter: (Under 70 lbs.) $ 174.08 – Includes pre-anesthetic exam, pain injection, pre-operative sedative, anesthesia, anesthetic monitoring, surgical drapes, pack, suture, and Doctor’s surgical fee for Neuter, hospitalization and recovery.

For every pound over 70 lbs, an additional $1.00 will be added to the current Spay or Neuter price.

Scrotal Ablation: $ 149.83 (in addition to neuter price) – Recommended on larger dogs to remove the scrotal skin after neuter. This helps prevent infections, or complications, after surgery.

Complicated Surgery Fee due to Heat, Pregnancy, or Obesity: $ 55.39 – Pets that are in heat or pregnant need special precautions taken as additional bleeding may occur and complicates the surgery. Pets that are obese also cause the surgery to be more complicated and take longer. This fee is in addition to the cost of the surgery listed above.

Deciduous Tooth Extraction: $ 82.73 – $196.48 max – All dogs should lose their puppy teeth by 5 ½ months of age. If your pet has not lost their puppy teeth by this age, they should be surgically removed to prevent damage or abnormal placement of the erupting adult teeth, and to prevent excess tartar and plaque buildup. This is usually performed at the same time as the Spay or Neuter.

IV Fluids and IV Catheter: $ 156.85 (Included with Packages) – Allows us to administer fluids intravenously during surgery, to help maintain hydration and blood pressure. It also allows us to administer emergency medications if your pet’s heart stops during anesthesia. IV fluids are recommended on all patients and are required on all pets that are 7 years of age and older.

Pre-Anesthetic Blood Profile: $ 222.82 (Included with Packages) – Allows our Doctors to evaluate the functions of your pet’s liver, kidneys, electrolyte levels, and blood counts to make sure that it is safe for your pet to undergo surgery and anesthesia for the procedure. A pre-anesthetic blood profile is recommended on all patients, and required on all pets that are 7 years of age and older.

Post – Operative Pain Medications: $ 36.00 (Included with Packages) – Pain medication(s) aid in pain relief and assist in decreasing any discomfort your pet may have post-operatively. They can also help to prevent your pet from chewing at their incision and help speed their recovery.

Post – Operative Sedatives: $ 36.00 – $ 70.00 – If your pet is very active after surgery, sedatives may be recommended to help keep them calm during recovery. This is very important after Spays or Neuters to prevent your pet from opening their incision.

E – Collar: $ 12.00 – $ 20.00 (based on size)– This is highly recommended to help prevent your pet from chewing at their incision.

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SPAY AND NEUTER PROCEDURES – FELINE

SAVE ON OUR SPAY AND NEUTER PACKAGES!

All package prices include Surgery Fee, IV Fluids, IV Catheter, and Pre – Anesthetic Blood Profile and Post – Operative Pain Therapy. This is the best level of care recommended for your pet’s surgery.

Feline Spay or Neuter Package: $ 492.00

Feline Basic Spay: $ 142.02 – Includes pre-anesthetic exam, pain injection, pre-operative sedative, anesthesia, anesthetic monitoring, surgical drapes, pack, suture, and Doctor’s surgical fee for Spay, hospitalization and recovery.

Feline Basic Neuter: $ 68.58 – Includes pre-anesthetic exam, pain injection, pre-operative sedative, anesthesia, anesthetic monitoring, surgical drapes, pack, and suture, Doctor’s surgical fee for Neuter, hospitalization and recovery.

Complicated Surgery Fee due to Heat, Pregnancy, or Obesity: $ 55.39 – Pets that are in heat or pregnant need special precautions taken as additional bleeding may occur and complicates the surgery. Pets that are obese also cause the surgery to be more complicated and take longer. This fee is in addition to the cost of the surgery listed above.

E – Collar: $ 12.00 – $ 20.00 (based on size)– This is highly recommended to help prevent your pet from chewing at their incision.

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Grades of Canine Tartar
GRADE I: Normal, Mild plaque present, No Tartar
GRADE II: Moderate plaque, Tartar covers <50% of tooth
GRADE III: Moderate tartar, Tartar covers 50-80% of tooth
GRADE IV: Severe tartar, Tartar covers 80-100% of tooth

Grades of Periodontal Disease *Cannot completely grade until animal is under sedation
GRADE 0: Normal, Some plaque, No bone loss
GRADE I: Mild gingivitis/redline, No bone loss, Reversible changes
GRADE II: Moderate gingivitis, <25% bone loss, Swollen gums, Odor is noticeable GRADE III: Severe gingivitis, >25% bone loss, Gingival recession, Sore mouth, May be irreversible
GRADE IV: Severe gingivitis, >50% bone loss, Severe recession, Loose teeth, IRREVERSIBLE

Why is treating and prevention of dental disease important?
Dental disease predisposes to: Renal failure, heart failure, liver failure, systemic bacterial infection, lung infections, jaw fractures, pain, bone infection, and weight loss. Preventing periodontal disease from advancing into the high grades decreases the cost for dental care!!!!

Treatment options:
CONCIOUS SEDATION DENTAL: $195
Includes: Sedation, ultrasonic scaling, oral charting, dental probe, low speed polish, fluoride treatment, SQ fluids, antibiotic injection.
*Blood profile & IV fluids required for animals over 7 years of age for an additional cost of $95.
*Only available for Grade 0 – 1 periodontal disease, not available for brachycephalic breeds.
*Cost to convert to anesthesia if necessary – $50.00

ANNUAL DENTAL CLEANING: $442
Includes: Basic chemistry/CBC blood profile, pre-anesthetic evaluation, anesthesia, ultrasonic scaling, oral charting,
dental probe, low speed polish, fluoride treatment, IV fluids, antibiotic injection, pain injection, dental x-rays.

EXTRACTIONS – Necessary for most Grade III and all Grade IV periodontal disease $80 – $308/tooth

FULL MOUTH EXTRACTION – Cost in addition to Dental Cleaning price: $2,200 – $2700

ANTIBIOTICS – May be required prior to and/or following dentals. $60-90 approximately

PAIN MEDICATIONS – Required to go home when extractions are performed. $36

BONDED SEALANT – Used to preserve a tooth with fractures that are still viable $103.41/tooth

GINGIVAL RESECTION – Removal of excessive gingival tissue $174.37/side

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Addison’s Disease (Canine Hypoadrenocorticism)

Adrenal Hormones:

The adrenal gland is so named because it is located just forward of the kidney (renal means kidney). The center of the gland is called the medulla and the outer area is called the cortex. While both areas produce hormones, Addison’s disease concerns the hormones produced by the cortex; these hormones are called corticosteroids.

Corticosteroids are the hormones that enable us to adapt physiologically to stress. The glucocorticoids (such as cortisol and related synthetics, prednisone and dexamethasone and numerous others) act on the mechanics of sugar, fat, and protein metabolism. They gear the metabolism towards the preparation of burning rather than storing, fuels so as to be ready for a fight or flight situation.

The mineralocorticoids (such as aldosterone and related synthetic fludrocortisone acetate) influence the electrolytes: sodium and potassium. As a general biological rule, where there’s sodium or salt, there’s water. When the mineralocorticoids circulate as part of the fight or flight preparation, sodium is conserved in anticipation of blood loss so that there will be extra fluid in the vascular compartment (spare blood). When sodium is conserved, potassium is lost as part of the biological balance.

This whole picture of fat mobilization, sodium conservation etc. that is part of the fight or flight preparation is far more complex than can be reviewed here but the bottom line is:

Corticosteroid hormones are needed to adapt to stressful situations and without these hormones, even small stresses could lead to physiologic disaster.
Hypoadrenocorticism (Addison’s Disease)
In animals with Addison’s disease, there is a deficiency of the corticosteroid hormones. It is unusual to discover the direct cause of this deficiency unless the patient is taking medications that disrupt adrenal balance (like ketoconazole, Lysodrenor trilostane) but, fortunately, the disease can be managed with the administration of corticosteroid hormones even if the cause of the deficiency is unknown.

Clinical Signs:

Patients are usually young (age 4-5 years) dogs but any age dog can be affected. (This disease occurs in cats but is very rare.) There is a genetic predisposition for Addison’s disease in the standard poodle and bearded collie. Female dogs are affected twice as often as males.

At first signs are vague – listlessness, possibly some vomiting or diarrhea. The pet just does not seem to feel right but not in an obvious way and may seem more or less normal most of the time as symptoms wax and wane with stress. Ultimately, the disease results in a phenomenon known as the Addisonian crisis. The animal collapses in shock due to his inability to adapt to the caloric and circulatory requirements in stress. Blood sugar may drop dangerously low. Potassium levels soar and disrupt the heart rhythm because there is not enough conserved sodium to exchange for potassium. Heart rate slows, arrhythmias result. The patient may not survive this episode.

Approximately 30% of dogs with Addison’s disease are diagnosed at the time of an Addisonian crisis.

Approximately 90% of the adrenal cortex must be non-functional to before clinical signs are observed.

Making the Diagnosis:

Because of the numerous symptoms that can be seen with Addison’s disease, Addison’s disease has earned the medical nickname The Great Imitator. You would think that you could simply look for an increase in potassium and/or drop in sodium on a basic laboratory blood panel, but it turns out spot checks of electrolyte values like this are not reliable enough for a diagnosis of Addison’s disease.

Veterinarians are typically presented with a young animal in shock. There is usually no history of trauma or toxic exposure so general treatment for shock is initiated. This consists of rapid administration of fluids (usually lactated ringers solution, which has little potassium and a moderate amount of sodium) plus some glucocorticoids. By coincidence, this also happens to be similar to the specific treatment for Addison’s disease so that often the patient simply recovers without the veterinarian really knowing why.

The blood panel will come back showing elevations in the renal parameters (BUN and creatinine) and thus with the elevated potassium is suggestive of acute renal failure, a condition with an extremely poor prognosis. The veterinarian may become suspicious of another diagnosis as the patient will respond well to fluid administration and most renal failure patients do not respond as well.

Addison’s disease may appear in more unusual ways. Inability to maintain normal sugar levels (ultimately manifesting as a seizure disorder) may be strongly suggestive of an insulin-secreting pancreatic tumor but before a major abdominal surgery is planned, it is important to test for Addison’s disease.

Similarly, unexpected regurgitation of undigested food due to abnormal nerve function in the esophagus (a condition called mega-esophagus) can ultimately be caused by Addison’s disease.

The only definitive test for Addison’s disease is the ACTH stimulation test. The patient receives a dose of ACTH, the pituitary hormone responsible for the release of corticosteroids in times of stress. A normal animal will show an elevation in cortisol in response to ACTH while an Addisonian has no corticosteroids to respond with. This lack of response is diagnostic for Addison’s disease; however, a false positive may be obtained if corticosteroids have been used in the treatment of the crisis prior to the test. Of all the commonly used corticosteroids, only dexamethasone does not interfere with the assay for cortisol; if any other steroid has been used, the test will not be valid for at least a couple of days.

Treatment:

The most important aspect of treatment for hypoadrenocorticism is the replacement of the missing mineralocorticoids hormones. One way to do this is with oral fludrocortisone (Florinef®). Florinef is given usually twice a day at a dose determined by the patient’s sodium and potassium blood tests. At first, these electrolytes are monitored weekly. When levels seem stable, these blood tests are repeated two to four times per year. Often with time, it will be found that the dose of Florinef needed to control the Addison’s disease will increase. This increase is unfortunate as the medication is relatively expensive. Since Florinef has glucocorticoid activity as well as mineralocorticoid activity, it is usually not necessary to use additional medications for treatment. Using a compounding pharmacy may be helpful in managing the costs of this particular medication, especially in a larger dog.

Another way to treat this condition is with an injectable medication called DOCP (brand name Percorten-V). This treatment is given approximately every 25 days. Electrolytes are measured prior to injections at first but testing can usually eventually be tapered to once or twice a year. There is some feeling among experts that DOCP produces better regulation of electrolytes than does oral Florinef. Some dogs however, do require glucocorticoid supplementation (such as a low dose of prednisone).

What is Atypical Addison’s Disease?

Approximately one dog in 42 will have a special form of Addison’s disease. To understand this form, we have to add some more details about the adrenal cortex. We have already explained that the adrenal cortex makes corticosteroids: the glucocorticoids that control sugar, fat, and protein use during stress and the mineralocorticoids that control electrolytes (mainly sodium and potassium) during stress.

The adrenal cortex has three layers: the zona fasciculata, the zona reticularis, and the zona glomerulosa. The inner two layers make the glucocorticoids and the outer zona glomerulosa layer makes the mineralocorticoids.

Most dogs get Addison’s disease when all three layers of the adrenal gland are destroyed and no corticosteroid hormones of any kind can be produced. With atypical Addison’s disease, the problem is limited to the layers that produce the glucocorticoids. This creates a patient who cannot regulate blood sugar normally but who is not at risk for an Addisonian crisis.

Diagnosis is still done with the ACTH stimulation test.

Treatment consists of supplementing glucocorticoid hormones, such as prednisone. Often these patients ultimately progress to the more typical Addison’s disease, complete with electrolyte imbalance.

A similar deficiency in glucocorticoids (but not mineralocorticoids) results when a pet has been on long-term oral glucocorticoids (such as prednisone) and medication is discontinued too abruptly. Long term glucocorticoid use leaves the outer layers of the adrenal cortex with nothing to do (and no stimulation from the pituitary gland since pills or shots are providing the body with more than enough glucocorticoids. Once the medication is withdrawn, the body is back to relying on its own adrenal glands for glucocorticoids but the gland has atrophied from lack of stimulation. This creates a deficiency in glucocorticoids similar to atypical Addison’s disease and is the reason why steroid hormones are typically tapered off rather than abruptly discontinued. True atypical Addison’s disease can be distinguished from overuse of medication by a plasma ACTH level (high in atypical Addison’s and low with medication overuse).

What is Pacific Rimism?

Dog breeds originating in the Pacific Rim, such as the Akita and Shiba inu, commonly have elevated potassium levels on blood tests. This can be confusing when a patient has symptoms that suggest Addison’s disease. These patients will have normal ACTH Stimulation test results if they do not have Addison’s disease.

Whipworm Infection?

Whipworm infection has been known to create a syndrome nearly identical to Addisonian crisis, complete with abnormal sodium and potassium values. These patients will have normal ACTH stimulation tests but because whipworms only periodically shed eggs, fecal testing may not detect whipworm infection. If there is any question about whipworm infection, treatment should be instituted.

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Feline Urinary Obstruction

Urinary obstruction is a blockage of the flow of urine out of the body. Obstructions are often the result of plugs of inflammatory material or small calculi or “stones” that have formed in the kidneys and have passed down into the bladder and become lodged in the urethra(the tube by which urine is drained from the bladder out of the penis or urethral opening). The cause of the inflammatory materials and stone formation is not well understood, though viral infections and diet may play a role. Male cats can easily develop obstruction of the urethra and it is a somewhat common occurrence for them, because the urethra/penis is much smaller in male cats as compared to female cats. Risk factors for urinary obstructions include: being overweight or neutered, living in a dry environment, stress in the household, having congenital defects of/or having trauma to the urethra, certain diets, low water intake or dehydration, and drinking water with high mineral content.

Besides being extremely painful, urinary blockages can lead to potentially irreversible kidney damage, heart arrhythmias, and bladder or urethral rupture. If left untreated urethral obstructions usually prove to be fatal in 3-6 days. If treated aggressively, 99% of the cats affected survive.

The accepted standard for treatment is to place a urinary catheter under sedation or anesthesia in order to remove the blockage, and allow a source for urine to leave the body. The patient is then hospitalized and treated with large amounts of IV fluids, pain medications, and anti-spasm medications for the urethra. The urinary catheter is left in for 24 hours past when the urine becomes clear of the presence of blood. At this point, the urinary catheter is then removed and the patient is kept on fluids for another 24 hours and the patient is monitored for urine production and/or re-obstruction. 50-75% of cats treated in this fashion never re-obstruct. Of the cats who do re-obstruct, 75% of them will re-obstruct in the first 48 hours after the urinary catheter was removed.

Urinary catheterization carries risks; however, if they are not unblocked the general outcome of this condition is fatal. In a small percentage of cases the urethra can tear while placing a urinary catheter, also there is a small percentage of cases where a urethral catheter is unable to be passed. In the event of the urinary catheter not being able to be passed, a Perineal Urethrostomy surgery is required at that time (see more information on this below). Another temporary option for relief of the pressure in the bladder is cystocentesis. This option only provides temporary relief and will not generally resolve the condition.

If re-obstruction occurs, there are three treatment options: Replace the urinary catheter, this time leaving it in twice as long as it was left in on the first attempt, to proceed with surgery at this time if doctor deems it necessary, or a humane euthanasia.

Perineal Urethrostomy Surgery:

This is a very invasive surgery, where the penis is removed and thus shortens the urethra, and in essence gives the male cat a urethral opening the size of a female cat to assist in alleviating the issue of re-blocking. This surgery has up to an 86% success rate; however, it does have risks. Cats that have undergone a P.U. surgery have a much higher risk for urinary tract infection for the remainder of their life. Other complications include: re-obstruction despite the surgery being performed, urethral stricture (where the urethrostomy site closes and scars as the tissues heal and the pet will then have difficulty urinating again, and thus may necessitate additional surgery which may not be successful), and urinary or fecal incontinence for life. Generally this surgery is not recommended unless a patient has experienced multiple obstructions.

If there are actually bladder stones and not just grit or debris in the bladder seen on x-ray or ultrasound, a surgery that may be offered would be a Cystotomy. This surgery involves cutting into the bladder itself and removing the stones to prevent obstruction.

Treatment options:

Recommended initial treatment: 2-4 days hospitalization & Diagnostics

Price includes: Initial exam, x-rays, initial blood work, urinalysis, unblocking procedure, anesthesia/sedation, IV catheter and fluids, pain medications, A-Cyst for bladder inflammation, medications to relax the urethra, antibiotics, hospitalization, recheck blood work, and go home medications. $ 3,400 – $ 6,400

*Sometimes it takes more time for the urine to become clear or the patient may re-obstruct, if either of these are the case additional days may be needed, resulting in additional fees. This is the medically accepted standard of care for this condition.

Outpatient Care with Diagnostics:

Price includes: Initial exam, x-rays, initial blood work, urinalysis, unblocking procedure and ozone saline flush of the bladder, anesthesia/sedation, A-Cyst for bladder inflammation, pain medications, medications to relax the urethra, and antibiotics. $ 1,050 – $ 1,600

*This option has a high occurrence of re-obstructing and is not generally recommended.

Outpatient Care – No Diagnostics:

Price includes: Initial exam, unblocking procedure and ozone saline flush of the bladder, anesthesia/sedation, A-Cyst for bladder inflammation pain medications, medications to relax the urethra, and antibiotics. $ 900 – $ 1000

*This option has a high occurrence of re-obstructing and is not generally recommended.

If any of these treatments are unsuccessful, initial diagnostics deem it necessary, or re-obstruction occurs, the options for treatment may or may not include the following:

Re-obstructed : 4+ additional days in hospital after initial hospitalization:

Price includes: Unblocking procedure, anesthesia/sedation, recheck blood work, IV fluids, pain medications, medications to relax the urethra, antibiotics, and hospitalization. $ 2,800 – $ 4,000 * Please note this does not include the previous charges from the initial hospitalization.

Cystotomy:

Price includes: Surgery, anesthesia, medical packs, pain and antibiotic injections, surgical technician, monitoring, ozone saline flush of the bladder and stone analysis, etc. $ 2,800 – $ 3,500

*Please note this cost is in addition to one of the “unblocking” options.

*This surgery should be performed if large stones are present in the bladder.

P.U. (Perineal Urethrostomy) Surgery:

Price includes surgery, anesthesia, medical packs, pain and antibiotic injections surgical technician, monitoring, etc. $ 3,800 – $ 4,950

*Please note this cost may be in addition to one of the “unblocking” options.

*This surgery will be recommended if a urethral catheter is unable to be placed on initial presentation, or if the patient continues to re-obstruct. This price does not include the cost of post-surgical hospitalization that may or may not be necessary. Surgery may be available with a boarded surgeon at an additional cost.

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Bite Wounds

Although dog bite wounds and cat bite wounds are quite common, they can be very severe and often life threatening. Unfortunately, animal mouths contain a large amount of bacteria and these wounds are very prone to severe infection. The crushing force of the bite and additional trauma from fighting can severely bruise and damage deeper tissues that may not be initially evident.

Due to the amount of trauma involved and high likelihood for infection, bite wounds are prone to ongoing complications such as necrosis(death) of tissues, dehiscence/failure of surgical closure, resistant infections, and other complications, even despite the most aggressive treatment.

The initial treatment of bite wounds involves aggressive flushing and attempted decontamination. Bite wounds are very painful and deep sedation is usually needed to get adequate cleaning and debridement completed. Multiple oral pain medications are also sent home to keep patients comfortable while they heal. Many bite wounds contain deep pocketing from the trauma involved and external drains are needed to help with proper drainage and prevention of infection. Puncture wounds, and most bite wounds in general, are intentionally left open to allow for drainage, as it is impossible to remove all of the bacteria introduced from the bite.

Depending on the severity of the wounds, Hospitalization, IV fluids and IV antibiotics may be recommended to most aggressively treat and help prevent infection. Less severe wounds can often be treated with oral broad spectrum antibiotics. If wounds are not responding appropriately, bacterial culture and sensitivity is needed to rule out an antibiotic resistant infection.

Unfortunately, animal bite wounds are very unpredictable in how they will respond to treatment and owner vigilance is needed to watch for any early signs of complications. Initial treatment generally ranges anywhere between $500-$1500; this does not include hospitalization or additional costs possibly needed for severe trauma cases involving broken bones or penetration into the trachea, chest, or abdomen. Many bite wounds will require multiple sedated procedures for debridement and revision of closures that will incur additional costs from the initial treatment. Veterinary attention to any concerns is very important to allow for the best and most effective treatment. Prompt treatment of the wounds is the best way to try and prevent infection or future complications, but there is no guarantee even with treatment that the wounds will be treated in a one-time visit, and often require multiple veterinary treatments to heal.

For infected wounds or wounds that are not surgically repairable at the time, bandaging is often needed to help draw out infection and start the healing process. This usually requires once daily to twice daily bandage changes done by a veterinarian over several days to weeks, depending on how the wound responds. Each bandage change ranges from $65-$120 (based on size and location of wounds), and further sedated surgical debridement is often needed which would also incur additional charges. Complications associated with wet or soiled bandages are also common, and owners need to be very careful to keep bandages clean and dry, and bring any concerns to their veterinarian’s attention immediately. It is also very important to keep the pet from licking, chewing, or scratching at any wounds or bandages to prevent further damage/infection and allow the wounds to heal. An e-collar (cone) is usually needed to be kept on at all times to prevent this behavior.

Hyperbaric Oxygen Therapy is a medical treatment that allows 100% oxygen to be delivered into the body under deep compressions. Large amounts of oxygen can diffuse four times deeper into the tissue than oxygen carried by red blood cells, and can help save and revitalize wounded tissues. This may also help to prevent additional surgeries due to infection and dehiscence by up to 75%, and may be recommended 2 to 3 times daily until wounds are healed.

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Intervertebral Disk Disease (Herniations of the Disk)

Intervertebral disks are located between the vertebrae (bones of the spine). Each disk has two parts, a fibrous outer layer and the jelly-like interior. When disk herniation occurs, the interior either protrudes (bulges) or extrudes (ruptures) into the vertebral canal, where the spinal cord resides. The onset of herniations can be either acute or chronic. When the spinal cord is compressed by this disk material, the dog or cat experiences signs ranging from mild back or neck pain to paralysis of limbs, loss of sensation, and loss of bladder and bowel control. Sometimes a disc herniation can be seen on radiographs (see below) but it may take more specialized studies of the spine (MRI or CT scan or a myelogram) to see the exact site where the disc herniated; this is especially true if surgery is part of the treatment plan because the surgeon must be sure of the exact rupture site.

Intervertebral disk disease sometimes occurs in cats, but it is not as common as it is in dogs, especially in the long, low chondrodystrophic breeds (e.g., dachshund, basset hound, beagle, Cocker spaniel, Shih Tzu, Lhasa apso, Pekingese, and corgi). In these breeds, there is a genetic predisposition for degeneration of the inside of the disk due to the animal’s conformation, which predisposes the disk to herniation. These chondrodystrophic dogs tend to get the bulging extrusions. Larger breeds of dogs are more typically affected with protrusions.

Although most disk herniations are caused by degeneration of the disk, they can also be caused by physical trauma (an accident, such as being hit by a car).

Disk herniation can occur anywhere along the spine but is commonly seen in the mid back area, the lower back area, and the neck area. Disk herniation in the mid back to lower back area may cause paralysis of the hind limbs and inability to properly urinate or defecate. Disk herniation in the neck often causes neck pain or limping on one front limb; however, it can also cause paralysis of all four limbs.

Age

In affected dogs of chondrodystrophic (long, low-slung) breeds, disk degeneration occurs within the first few months of life, but the actual herniation doesn’t occur until the dog is typically over 3 years of age. The herniation may have a very sudden in onset, i.e. suddenly extruding into the spinal canal where the spinal cord runs. In non-chondrodystrophic breeds, the disk degeneration starts later in life and the herniation may occur more slowly over time (slowly protruding or bulging disc).

Grading of Clinical Signs and Diagnosis

A neurological examination allows the severity of clinical signs to be graded as follows:

Grade 5: normal

Grade 4: ambulatory, but mildly paraparetic (weak/wobbly)

Grade 3: markedly paraparetic (weak/wobbly), but is able to get up on his/her own

Grade 2: severely paraparetic (weak/wobbly); good voluntary motion still present in hind limbs, but cannot get up without assistance

Grade 1: slight voluntary limb motion present

Grade 0: paraplegic (no voluntary motion present). This grade is further subdivided as to whether or not the patient can feel any deep pain sensation in the affected limbs.

A tentative diagnosis is based on age and breed of patient, clinical signs, and spinal radiographs. Remember, though, that disc herniations are not always as visible as the one demonstrated in the above radiograph; some are impossible to see without more specialized imaging. Therefore, a definitive diagnosis usually requires myelography, MRI, or CT scans of the spine. Myelography is a type of imaging involving the injection of a contrast agent (a liquid that x-rays don’t go through) into the spinal canal to pinpoint the compressed area of spinal cord. CT or MRI scans are also another way to see more clearly if a disk is the cause of the problems. These tests require general anesthesia, at which time the attending veterinarian may also remove some spinal fluid and have it analyzed for signs of other diseases that can mimic a disk herniation.

Treatment and Prognosis

Mild cases that are not paralyzed are often managed medically. Confinement to a crate with minimal physical activity (no jumping, no running, no going up/down stairs, no playing, etc.) is necessary for several weeks. Pain medication may be prescribed by your veterinarian during the confinement.

Surgical intervention may be recommended if medical management isn’t working, if the pain can’t be controlled, or if the patient is paralyzed. Surgery is often the quickest way to get function to return. However, the success of the surgery depends on the amount of damage that the spinal cord has incurred and how long of a time period the disk has been compressing the spinal cord. The neurological examination will help to determine the degree of damage as well as estimating the prognosis for return of function. In general, more than 90% of the dogs who have the ability to sense pain in their hind limbs will walk again after surgery; this decreases to 60% or less if the patient has lost the ability to sense deep pain sensation in their limbs. Surgery to treat disk herniation requires the expertise of a veterinarian with training in disk surgery, which is usually a surgical specialist, a neurologist, or a neurosurgeon.

With either medical or surgical treatment, the pet owner will need to provide nursing care for the pet during the recovery phase. This may mean keeping the pet confined to a small space while it is recovering, keeping it calm and quiet, carrying it outdoors frequently for eliminations, assisting with urination and defecation, flexing and extending joints to keep them flexible, etc. Consult with your veterinarian as to how you can assist your pet during recovery. More intensive physical therapy may be needed in some cases. Full recovery usually takes several weeks and, in some cases, even several months.

The prognosis depends on how severe the clinical signs are, how long the problem has been present, which treatment is selected, and how the patient responds to treatment. Most animals respond well if veterinary advice is followed, but some patients end up with permanent paralysis and fecal/urinary incontinence despite proper treatment and management.

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Back Injury or IVDD Recommendations

These are a list of the things that the Veterinarians at the Scottsdale Veterinary Clinic may recommend for back pain or back injury with your pet.

CT (Computed Tomography) – A CT scan of the spine may be necessary in diagnosing the extent of the spinal injury or degeneration. Herniations of the disc may require Surgical intervention if medical management is not an option, depending on the grade of clinical signs.
Pain Medications – Tramadol, Methadone, hydromorphone, and buprenorphine are morphine type products that can help with back pain. This product may cause constipation; therefore, laxatives are recommended.
Amantadine – Used for treatment of chronic pain. It works by partially blocking a receptor within the central nervous system that is associated with pain pathways. Works best combined with other pain relievers such as NSAIDS, gabapentin, and/or tramadol.
Gabapentin – Used to treat chronic neuropathic pain, often caused by spinal injuries. Works best combined with other pain relievers such as NSAIDS, tramadol, and/or amantadine.
Muscle Relaxants – Methocarbamol or Diazepam may be used to help reduce the amount of muscle spasms that your pet may experience with back pain. These are recommended if they are restless, panting, or unable to sleep at night.
Weight Loss and Exercise – if your pet is overweight we will recommend weight loss. Exercise is recommended to keep the muscles in the back strong. Leash walk or swimming is the best exercise. Absolutely no fetch, jumping should be allowed for the next month, as this type of exercise can continue to injure the back.
Anti-Inflammatory Medications – May include rimadyl, metacam, etc. These cannot be given with any type of cortisone, and should be discontinued if any vomiting or diarrhea is noted.
Steroid Therapy – Prednisone (cortisone) may be recommended for disc disease, this cannot be given with any aspirin type products. Some potential side effects include: diabetes, liver disease, immune suppression, and stomach ulcers.
Fiber – We recommend fiber to prevent constipation. Some sources of fiber include canned pumpkin, benefiber, vetasyl, or metamucil. Give 1-4 tablespoons of canned pumpkin per feeding. Give 1/4 – 1 cracker of metamucil 2 times per day. Docusate sodium (Colace) may also be recommended for constipation.
Injectable Adequan – Can speed healing with arthritis and with disc disease. This is usually given 1-2 times per week for one month, then monthly.
Heat and Massage Therapy – Applied on the area that is painful may help relax the muscles and aid in recovery. This can be performed daily at home.
Acupuncture and Chiropractic Adjustment – Dr. D’Monte has had some significant success in treating back pain and back injuries.
Supplements – Duralactin is highly recommended as an effective anti-inflammatory agent for arthritis in the back and back injuries. This will probably be recommended for life if your pet injures their back. Fish oil appears to be helpful in the treatment and prevention of back injuries and arthritis. Fish oil does take some time to build up in the body to start showing its effectiveness.
Hyperbaric Oxygen Therapy – During HBOT, 100% oxygen flows into the hyperbaric chamber under pressures of 1.5 to 3 times that of normal atmospheric pressure. Very large amounts of oxygen are dissolved in the plasma, and can diffuse 4 times deeper into the tissue than oxygen carried by the red blood cells. This assists in reducing swelling, inflammation, pressure, and edema that is often caused by spinal cord injuries and promotes healing.

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HARMFUL HOUSE PLANTS

Plant Name	System Affected	Details
African Violet	Heart	Leaves & stems are poisonous
Amaryllis	Intestines & Brain
Anthurium	Kidney & Liver
Apricot	Lungs	Pit contains cyanide
Autumn Crocus	Intestines & Heart
Azalea	Intestines
Begonia	Kidney & Liver
Caladium	Mouth/Skin	Severe irritation of mouth and tongue
Calla lily	Kidney & Liver
Century plant (Agave)	Heart	Saponins in root may be fatal
Choke cherries	Lungs	Unripe berries contain cyanide
Chrysanthemum	Skin	Rotten plants cause severe skin irritation
Daffodil	Intestines	Bulbs cause intestinal upset/death
Delphinium	Brain
Dieffenbachia	Intestines & Lungs	May cause fatal swelling of throat
Dumbcane (Dieffenbachia)	Mouth/Skin	Juice causes swelling of mouth/throat
Elderberry	Lungs	Unripe berries contain cyanide
Elephant’s ear (Colocasia)	Mouth/Skin	Severe irritation of mouth and tongue
English Ivy	Lungs	Berries & leaves cause breathing difficulty & coma
Eucalyptus	Heart	Cyanide poisoning
Four o’clock (Mirabilis)	Intestines	Roots and seeds cause stomach upset
Foxglove	Heart
Heliotrope	Heart	Leaves are poisonous
Hydrangea	Lungs	Stomach upset and bloody diarrhea
Iris	Intestines
Kalanchoe	Heart
Lantana	Liver
Lily of the valley	Heart
Mistletoe	Heart & Brain
Morning glory	Brain	Seeds are toxic to birds
Oleander	Heart	Very poisonous, one leaf can be fatal
Peach	Lungs	Pit contains cyanide
Pencil cactus	Intestines
Peperomia	Heart	Leaves are poisonous
Petunia	Heart	Contains poisonous alkaloids
Philodendron	Kidney & Liver
Poinsettia	Mouth/Skin	Juice is irritating to mouth/tongue/intestines
Prayer plant	Intestines	Leaves are toxic
Primrose	Skin	May cause severe skin irritation
Rex begonia	Intestines	Causes vomiting
Rhubarb	Kidney & Liver
Rubber Plant (Ficus)	Skin	Severe skin irritation
Sago Palm	Heart & Liver	Wobbling, liver inflammation
Scheffelera	Kidney & Liver
Sweet violets	Intestines	Rhizomes and seeds cause upset stomach
Taxus	Heart
Wormwood	Brain	Oils can cause brain damage

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DENTAL CARE RECOMMENDATIONS:

Periodontal disease is PREVENTABLE with routine cleanings and routine preventative measures performed at home. Here are some ways you can help PREVENT Dental Disease in your pet:

Our first recommendation is starting your pet on OXYFRESH – it is an easier – less time –consuming method of preventing Tartar buildup and bad breath – In addition to preventing new tartar from forming – OXYFRESH bonds to tartar and breaks it off the teeth. Simply lift up their lips and spray it on the teeth every night until Tartar is gone – Than you can decrease to 2 – 3 times a week; Like most products – OXYFRESH is most effective if used daily – but using it a couple of times a week is better than none at all.
You can also treat your dog or cat to Dental Chews – For dogs – we recommend CET HEXTRA CHEWS – They have enzymes that are in toothpaste built into the chew as well as an antibacterial agent – Chlorhexidine Gluconate – These help to scrape tartar and plaque off the teeth and rid the mouth of bacteria – If you purchase chews from a local pet store – please keep in mind that they must be “enzymatic” to be effective – WE also carry CET CHEWS for cats in both poultry and fish flavor.
And lastly – but possibly the most important aspect to Dental Care – We recommend you try brushing your pet’s teeth at least three times a week – You can buy toothpaste and toothbrushes at The Scottsdale Veterinary Clinic or at a local pet store – We know it can be difficult to brush your pet’s teeth so here are a few ideas that may help you be more successful in performing this task:

Always put your pet someplace where they are NOT alone – such as a bathtub, table or counter
ALWAYS use a VERY soft bristled brush or finger brush – You can even start out by using your finger for the first few brushings to help your pet get used to the experience and the toothpaste
Do NOT use Human toothpaste – It contains Soap and Other ingredients that should NOT be swallowed – These ingredients could make your pet ill
Use pet toothpaste – We sell three flavors of the CET Toothpaste – or you may make your own toothpaste from equal parts of salt and baking soda – Simply place the “Toothpaste” on a wet toothbrush or soft cloth
Brush with a circular motion along the gum line and both the insides and outsides of their teeth
Be sure to feed your pet a special crunchy treat or dog food after brushing – Rewards for good behavior will help your pet understand that brushing is fun and should be done as often as possible
Try feeding dry crunchy food and treats – These will help to scrape plaque off the teeth
Every dog and cat are different and some are more prone to dental disease than others – Therefore periodic dental exams and regular cleanings are important to maintain your pet’s good health

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GENERAL RECOMMENDATIONS FOR ARTHRITIS:

These are a list of the things that the Veterinarians at the Scottsdale Veterinary Clinic may recommend for arthritis in your pet:

SUPPLEMENTS – These are very safe products to help decrease inflammation, heal the joint, and reduce pain in your pet. Side effects are minimal with these supplements and usually involve stomach upset or diarrhea. They work in different mechanisms so one or all of them may be recommended. These are usually started in the early stages of arthritis. Additional medications are added as arthritis progresses.

Fish Oil- Wellactin- Omega 3 fatty acids (DHA) is recommended for arthritis. This is especially important with arthritis patients with kidney disease. Very safe, in overdosage may cause acid reflux or diarrhea. If used in very high doses (especially with aspirin products) may cause prolonged bleeding. Dose is generally 100 mg per 10 pounds.
Glycoflex- Glucosamine, chondroitin, MSM supplements are beneficial for multiple types of arthritis and appear to aid in cartilage health. Generally, 100 mg/ 10 pounds of body weight is the recommended dosing for glucosamine. Glucosamine products should be used cautiously with diabetic patients.
Cetyl-M- This joint supplement uses Cetyl Myristoleate as the main ingredient. This supplement helps in lubricating the joints. This is highly recommended for hip, knee, shoulder, elbow, and carpus arthritis. This supplement is very effective for arthritis/tendon sheath pain. This is commonly used for animals that are chewing over a joint.
Duralactin- This product uses milk proteins to reduce inflammation in the body. This product is very safe and has been used in most species of animals with almost no side effects. This is highly recommended for back arthritis/pain.
Niacinamide- This is one of the B vitamins and appears to help with arthritis- the dose is 500 mg for dogs over 25 pounds, and 250 mg under 25 pounds. Give the dose 3 times per day. This product is very safe and inexpensive.
Adequan Injections – This is an injectable product that can help especially with spinal arthritis in many species of animals. This is and injectable form of chondroitin and works much more rapidly than oral forms of chondroitin. Should not be used with bleeding disorders. This injection is given every 1-4 weeks to help with arthritis.

LIFESTYLE CHANGES – Weight loss and exercise are critical to the management of arthritis. If your pet is overweight, changes such as decreasing treats, changing to a diet or prescription weight-loss food, and increasing the amount of low-impact exercise such as swimming, will help to decrease pain and support the joints.

PRESCRIPTION DIET – Prescription formulation diets are recommended to provide fish oil, glucosamine, chondroitin and other supplements. This is an especially good option for patients that may be difficult to medicate. Royal Canin Mobility Support and Hills j/d are excellent options for joint supplementation. Reevaluate how much food you are giving each day as these foods are high in fat (fish oil) and may cause weight gain.

COLD LASER THERAPY – These treatments stimulate stem cells to re-activate and continue the healing process. This also appears to aid in blood flow and reduce muscle spasms in the area. These treatments are performed weekly for one month, then once monthly as needed. These especially help during the cold winter months when arthritis flairs up.

ACUPUNCTURE – Can be used to stimulate blood flow and pain release with arthritis.

CHIROPRACTIC ADJUSTMENTS – Can be very helpful if your pet has a neck or back injury.

MASSAGE THERAPY – This is recommended for home use and is very effective for muscle spasms. This therapy can be combined with tail pulls (stretches) to help with muscle aches and pains.

STEM CELL THERAPY – We now have the ability to harvest your pet’s stem cells, grow, and inject them back into their joints. This is very helpful for chronic arthritis conditions, in multiple joints.

PROLOTHERAPY – This therapy aids in the healing of joints by using your pet’s own platelets and growth factors to help with healing. This is recommended after an acute injury when we want to stimulate scar tissue.

NSAIDs – Aspirin, Rimadyl, Metacam, Previcox, and Deramax are anti-inflammatory medications that help with arthritis pain. Only one of these medications can be used at a time to avoid serious side effects, such as liver failure, stomach ulcers, etc. These should not be used with cortisone. Recommend checking bloodwork 3-4 weeks after starting these medications and every 6-9 months thereafter to ensure proper kidney and liver function. These products appear to work better if they are not used on a continuous basis. These products work better in chronic arthritis pain, than acute injuries where scar tissue creation is important.

PAIN MEDICATION – Sometimes the combination of a cartilage-protecting agents and an anti-inflammatory drug is not adequate for pain control. There are several appropriate pain relievers that can be used in pets. These medications are strictly analgesics and do not modify the inflammation in the joint.

Tramadol – This is an oral pain medication that has few side effects. This product is morphine-like and works for many patients with arthritis pain. Other morphine products may be used however tramadol is less expensive and the only common side effect is constipation.
Amantadine – This is an oral medication that assists in pain relief by inhibiting receptors in the nervous system that create sensations of chronic pain. This medication has been used for pain relief in human therapy for arthritis, neuralgic pain and cancer. This medication has few side effects; however, can in some cases cause diarrhea and increased flatulence.
Gabapentin- This is an oral medication that can assist, in addition to other medications, in the relief of chronic pain, especially due to arthritis or neuropathic/nerve pain, and is safe for both dogs and cats. Common side effects are infrequent; however, can include diarrhea and sedation upon initial use. Side effects typically resolve after several days of continuous use. Use caution when using this medication in pets with kidney or seizure disorders. Gabapentin should not be abruptly discontinued after long-term use, and should instead be tapered down slowly.

ANABOLIC STEROIDS – Winstrol-V is an anabolic steroid which helps to build muscle and can help stimulate the appetite. It can sometimes cause liver issues. We recommend bloodwork every 3-6 months to evaluate liver function. This is generally used in an injectable form and generally in the last year of your pet’s life.

CORTISONE – (Prednisone) is a different type of steroid that will decrease inflammation but can increase food and water intake and urination along with weight gain. Prednisone cannot be used at the same time as the NSAIDs listed above. These products are generally given in the last year of life due to their potential side effects. They are inexpensive but commonly cause immune suppression, liver disease, diabetes, etc.

Feel free to discuss recommendation with one of our doctors for the ultimate health of your pet, if they are not rapidly improving with current therapy. (480) 945-8484

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Bone Fracture Treatment Options

The long bones of dogs and cats are almost identical to the bones of the legs and arms of people, and just like people, dogs and cats can break these bones due to trauma. A bone can break in many ways; this is called a fracture. Fractures are classified into several categories: Incomplete, Complete, Transverse, Oblique and Comminuted. The type of fracture will determine the length and cost of surgery and/or treatment. With surgical intervention, fractures have a more successful chance of healing as the instability is eliminated and this allows for the bone to adequately heal.

Surgery does dramatically improve the chances of the fracture healing, and by using plating, pin, and/or wire techniques, most fractures can be stabilized surgically. This depends on a case by case basis however. If there are financial constraints and surgery is not a viable option, external coaptation (splinting / bandaging) can be attempted. However, it must be reiterated that bone healing may not fare as well with external coaptation as it would with surgical repair. Some cases may require limb amputation depending on severity and financial constraints. Below is a range of options for treatment, comparing a surgical fracture repair with and without complications, external coaptation, and/or to limb amputation.

Surgical Options:

Fracture repair without complications

Price includes initial exam and x-rays, anesthesia, uncomplicated fracture repair, pain injections, antibiotics, overnight hospitalization, IV fluids, bloodwork, plate & screws for repair, post-operative pain medications, follow up exams and follow up x-rays. Estimated cost = $3,300 – $3,500

Fracture repair with complications

Price includes initial exam and x-rays anesthesia, complicated fracture repair, pain injections, antibiotics, overnight hospitalization, IV fluids, bloodwork, plate & screws for repair, post-operative pain medications, follow up exams and follow up x-rays. Estimated cost = $3,700 – $3,900

Limb Amputation

Price includes initial exam and x-rays, anesthesia, amputation procedure, pain injections, IV fluids, bloodwork, post-operative pain medications, antibiotics and overnight hospitalization. Estimated cost = $2,000 – $2,400

**Surgical options are only with qualified veterinarians, based on availability. Surgery may also available with a mobile Boarded Veterinary Surgeon if preferred. Average cost with Boarded Surgeon is $2000-$3000 additional to costs listed above. Would need a consultation with boarding surgeon for more accurate costs, based on case by case basis.

Non-Surgical Options (Splinting & Bandaging):

Includes initial exam and x-rays, pain medications, sedatives (if necessary), follow up splint and bandage changes, follow up exams and follow up x-rays.

External Splint & Bandage (small animal): $1,200 – $1,800

External Splint & Bandage (medium animal): $1,900-$2,200

External Splint & Bandage (large animal): $2,000 – $2,400

**These cost ranges are based on an average healing time of 6-8 weeks. Some cases may require longer treatment and may exceed the above estimated ranges.

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Feline Chronic Kidney Disease:

Diagnosis and Recommendations

Kidney failure is the one of the more common causes of death in dogs and cats. It is important to recognized kidney failure in the early stages (<70-85% loss of function) when your pet has minimal to no symptoms to prevent progression to the later, more severe stages. Kidney failure will not show up on most blood profiles until 85% of kidney function has been lost.

Watch for the following signs, which could indicate early kidney failure in your pet: weight loss, excessive drinking, excessive urination, constipation, and high blood pressure. Once severe symptoms have developed it is more difficult to treat your pet and kidney damage is difficult, or impossible, to reverse..

Stage 1 Kidney Insufficiency Diagnosis:

Blood kidney values are normal!!
Urine Specific Gravity (urine concentration) of early morning sample is less than 1.030 – 1.035. This means the urine is not concentrating correctly.
Or Protein is in the urine. If bloodwork is normal, but protein is in the urine, this is a sign of early kidney failure.
Abnormalities on ultrasound of the kidney may also indicate early kidney failure.
Urine culture, blood pressure, FELV/FIV, and x-rays are recommended.
Your pet will most likely appear normal at this stage of kidney failure!

Stage 1 Kidney Insufficiency Treatment:

Diet designed for kidney failure can double the life span of your pet at this stage. We recommend Hills K/D, D/M or Royal Canine Modified LP for life.
Make sure that your cat always has access to water. We recommend bottled drinking water, and a recirculating fountain to encourage them to drink more. Also keeping multiple water dishes around your home can remind your cat to drink more frequently.
Start Epakitin (phosphorus binder) to prevent additional damage to the kidneys. The goal is to maintain the phosphorus between 2.5 – 4.5 mg/dl on bloodwork.
Start fish oil (DHA) 10 mg per pound per day. A 10 pound cat would receive 100 mg of DHA per day. If too much is given they may develop diarrhea.
Recheck bloodwork and urine in 1 month. We will add Rehmannia-8 at that time, if the abnormal values have not improved. Rehmannia-8 is a dilator for the blood vessels in the kidneys to improve function.
Bloodwork and Urine will be rechecked every 3-6 months for the life of your pet, this will help adjust therapy as the disease slowly progresses. Blood pressure monitoring may be performed to make sure that additional medications are not required.
Treatment in this stage is important to prevent and slow progression of the kidney failure.
If your pet has dental disease a dental cleaning is recommended.

Stage 2 Kidney Insufficiency Diagnosis:

Blood kidney values are slightly elevated: Creatinine is 1.6 – 2.8
Urine Specific Gravity (urine concentration) of early morning sample is 1.015- 1.008.
Severe amount of protein may be present in the urine.
You may start to notice your pet is drinking more, losing weight, and acting more lethargic. They may not be grooming as well as normal.

Stage 2 Kidney Insufficiency Treatment:

Continue encouraging water consumption, kidney diet, fish oil, epakitin.
If not already started Rehmannia-8, may be started at this time.
If plasma potassium levels are low normal or low (less than 4.5 mmol/l) we will start potassium supplements.
If kidney infections are suspected, long term antibiotics may be recommended.
Bloodwork, blood pressure and urine will be checked every 3-6 months.
If your pet has dental disease a dental cleaning is recommended

Stage 3 Kidney Failure Diagnosis:

Moderate kidney value elevation- Creatinine is 2.8-5.0. BUN values are elevating.
Urine Specific Gravity is 1.012- 1.008 (No longer concentrating)
Many times anemia is noted on bloodwork.
Symptoms that your pet is showing include: drinking excessively, weight loss, frequent urination, vomiting, significant decrease in appetite, significant increase in lethargy. At this stage medications and treatments are necessary to maintain the quality of their life.

Stage 3 Kidney Failure Treatment:

Continue encouraging water consumption, kidney diet, fish oil, epakitin, Rehmannia-8, and potassium. If blood pressure medications are needed they may be added at this time.
Add Azodyl at this time. This is a bacteria that aids in digestion of the toxins in the kidneys.
Subcutaneous fluids may be recommended at this time. We give these fluids under the skin 2 times per week to help flush out the kidneys. This acts similar to dialysis to help flush out the kidneys. Adding flavoring to the drinking water may help stimulate them to drink more (can try Viyo or small amount of low-sodium chicken broth).
If albumin is low, egg whites may be recommended on a regular basis.
Vitamin B in the form of injections or pet tinic may also be recommended especially in cats. We can instruct you how to give the Vitamin B injections or you may come in for them on a regular basis.
At this stage bloodwork, urine and blood pressure should be checked every 3 months for life.
Appetite stimulants (mirtazapine, cyproheptadine, diazepam) may be recommended, if your cat is not eating well.
Famotadine and Sucralfate may be recommended to help settle the stomach.
If your pet has dental disease a dental cleaning is recommended.
If your pet has high blood pressure benazapril and/or amlodipine may be recommended.

Stage 4 Kidney Failure Diagnosis:

Severe kidney value elevation: Creatinine is greater than 5.0, and moderate to severe elevations in BUN.
Many clinical signs are usually present; including mouth ulcers, diarrhea, vomiting, dehydration, bone and joint pain, and anorexia.
Many values are irregular on bloodwork, including anemia.

Stage 4 Kidney Failure Treatment:

All previously recommended medications are continued. The doses of these medications may be increased or altered depending on bloodwork, urine, blood pressure, and clinically how your cat is doing. Medications will be required to prevent the rapid decrease in quality of life.
Dental cleaning may be recommended; however at this stage the dental will usually require additional hospitalization to flush out the kidneys before and after the dental. Antibiotics both before and after the dental will be required.
Aluminum Hydroxide may be added to help reduce phosphorus.
If diarrhea develops, Fortiflora may be recommended as a probiotic.
The fluids that are given under the skin may be increased to every other day, or even daily, if needed. If you are having trouble giving the fluids under the skin, a GIF tube may be implanted under the skin to allow you to give fluids quicker and easier.
If your cat is not eating well, we will discuss placing a feeding tube. This allows for easier access to perform feedings and administer medications.
If your cat is anemic, less than 20% on the PCV, we may recommend erythropoietin or darbepoietin.
To encourage your pet’s appetite, anabolic steroids can aid in kidney function and regrowth of red blood cells.
Arthritis medications or pain medications may be required for joint pain.
Hospitalization, IV fluids, and IV medications may be required to help flush out the kidneys.

Stage 5 Kidney Failure:

Stage 5 kidney failure will require dialysis or kidney transplant for survival and for most euthanasia is the best option.

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Canine Chronic Kidney Disease:

Diagnosis And Recommendations for Dogs

Kidney failure is the one of the more common causes of death in dogs and cats. It is important to recognized kidney failure in the early stages (70-85% loss of function) when your pet has minimal to no symptoms to prevent progression to the later, more severe stages. Kidney failure will not show up on blood profiles until 85 % of kidney function has been lost.

Watch for the following signs of early kidney failure in your pet: weight loss, excessive drinking, excessive urination, constipation, and high blood pressure. Once severe symptoms have developed it is more difficult to treat your pet.

Stage 1 Kidney Insufficiency Diagnosis:

Blood kidney values are normal- Creatinine is less than 1.4
Urine Specific Gravity (urine concentration) of early morning sample is less than 1.030. This means the urine is not concentrating correctly
Protein is in the urine. If bloodwork is normal, but protein is in the urine, this is a sign of early kidney failure.
Abnormalities on ultrasound of the kidney may also indicate early kidney failure.
Urine culture, blood pressure, tick fever test, and x-rays are recommended.
Your pet will most likely appear normal at this stage of kidney failure!

Stage 1 Kidney Insufficiency Treatment:

Diet designed for kidney failure can double the lifespan of your pet at this stage. We recommend K/D or Royal Canine Modified LP for life.
Make sure that your dog always has access to water. We recommend bottled drinking water to encourage them to drink more.
Start epakitin (phosphorus binder) to prevent additional damage to the kidneys. The goal is to maintain the phosphorus between 2.5 – 4.5 mg/dl on bloodwork.

Start fish oil (DHA) 10 mg per pound per day. A 50-pound dog would receive 500 mg of DHA per day. If too much is given they may develop diarrhea.

Recheck bloodwork and urine in 1 month. We will add Rehmannia-8 if the abnormal values have not improved. Rehmannia-8 is a dilator for the blood vessels in the kidneys to improve function.
Bloodwork and Urine will be rechecked every 3-6 months for the life of your pet, this will help adjust therapy as the disease slowly progresses. Blood pressure monitoring may be performed to make sure that additional medications are not required.

Treatment in this stage is important to prevent and slow progression of the kidney failure.
If your pet has dental disease a dental cleaning is recommended.

Stage 2 Kidney Insufficiency Diagnosis:

Blood kidney values are slightly elevated- Creatinine is 1.4-2.0
Urine Specific Gravity (urine concentration) of early morning sample is 1.015- 1.008.
Severe amount of protein may be present in the urine.
You may start to notice your pet is drinking more, losing weight, and acting more lethargic.

Stage 2 Kidney Insufficiency Treatment:

Continue encouraging water consumption, kidney diet, fish oil, epakitin.
If not already started Rehmannia-8 may be started at this time.
If plasma potassium levels are low normal or low (less than 4.5 mmol/l) we will start potassium supplements.
If kidney infections are suspected, long term antibiotics may be recommended.
Blood work, blood pressure, and urine will be checked every 3-6 months.
If your pet has dental disease a dental cleaning is recommended

Stage 3 Kidney Failure Diagnosis:

Moderate kidney value elevation- Creatinine is 2.1-5.0. BUN values are elevating.
Urine Specific Gravity is 1.012- 1.008 (No concentration)
Many times anemia is noted on bloodwork.
Symptoms that your pet is showing include: drinking excessively, weight loss, frequent urination, vomiting, significant decrease in appetite, significant increase in lethargy. At this stage medications and treatments are necessary to maintain the quality of their life.

Stage 3 Kidney Failure Treatment:

Continue encouraging water consumption, kidney diet, fish oil, epakitin, Rehmannia-8, and potassium. If blood pressure medications are needed they may be added at this time.
Add Azodyl at this time. This is bacteria that aids in digestion of the toxins in the kidneys.
SQ fluids may be recommended at this time. We give these fluids under the skin 2 times per week to help flush out the kidneys. This acts similar to dialysis to help flush out the kidneys. Adding flavoring to the water may help stimulate them to drink more- viyo or small amount of chicken broth.
If albumin is low egg whites may be recommended on a regular basis.
Vitamin B in the form of injections or pet-tinic may also be recommended.
At this stage bloodwork, urine, and blood pressure should be checked every 3 months for life.
Appetite stimulants (mirtazapine, cyproheptadine, diazepam) may be recommended.
Famotidine and Sucralfate may be recommended to help settle the stomach.
If your pet has dental disease a dental cleaning is recommended
If your pet has high blood pressure benazepril and/or amlodipine may be recommended.

Stage 4 Kidney Failure Diagnosis:

Severe kidney value elevation- Creatinine is greater than 5.0, and moderate to severe elevations in BUN.
Many clinical signs are present including mouth ulcers, diarrhea, vomiting, dehydration, bone and joint pain, and anorexia.
Many values are irregular on bloodwork including anemia.

Stage 4 Kidney Failure Treatment:

All previously recommended medications are continued. The doses of these medications may be increased or altered depending on bloodwork, urine, blood pressure, and clinically how your dog is doing. Medications will be required to prevent the rapid decrease in quality of life.
Dental cleaning may be recommended; however, at this stage the dental will usually require additional hospitalization to flush out the kidneys before and after the dental. Antibiotics both before and after the dental will be required.

Aluminum Hydroxide may be added to help reduce phosphorus.
If diarrhea develops fortiflora may be recommended.
The fluids that are given under the skin may be increased to every other day or even daily if needed. If you are having trouble giving the fluids under the skin a GIF tube may be implanted under the skin to allow you to give fluids quicker and easier.
If your dog is not eating well we will discuss placing a feeding tube. This allows easier access to perform feedings and administer the medications.
If your dog is anemic- less than 20 on the PCV we may recommend erythropoietin or darbepoetin.
To encourage your pet’s appetite anabolic steroids can aid in kidney function and regrowth of red blood cells.
Arthritis medications or pain medications may be required for joint pain.
Hospitalization, IV fluids, and IV medications may be required to help flush out the kidneys.

Stage 5 Kidney Failure:

Stage 5 kidney failure will require dialysis or kidney transplant for survival and for most, euthanasia is best for the patient.

______________________________________________________________________________________________________

Medical Management of Cruciate Disease:

Depending on your pet’s individual situation, surgery might not be a first or realistic option. Here are some medical alternatives that may be right for you and your pet:

Cetyl-M: Cetyl myristoleate is a supplement recommended for the treatment of osteoarthritis and joint disease in dogs. It helps to relieve pain, increase range of motion and improve mobility. This product is highly recommended for the first month after a ligament injury to see if it will heal on its own. If still limping after a month generally surgery is necessary. Cost is $50-$130 dollars.

PRP: Platelet rich plasma uses a growth factors derived from your pet’s blood to enhance the body’s natural healing process. This is achieved by delivering a high concentration of growth and healing factors at an injured site. PRP is especially recommended if you cannot afford surgery, if your pet has a partial tear, or they already have arthritis in the joint. Cost is $500-$900 dollars depending on the number of injections.

Prolozone: This joint injection pairs ozone therapy and prolotherapy to initiate a healing cascade. This cascade then works by strengthening tendons and ligaments which reduces inflammation and relieves arthritic pain. Many times, this therapy is combined with PRP. If performed with PRP there is no additional cost, but if performed alone, estimated cost is $370-$500 depending on number of injections.

Braces: A custom brace made specifically for your pet that works to alleviate pain and lameness, offer support and maintain quality of life. These braces are generally ineffective for healing the joint, but may stabilize it enough to improve quality of life. May be recommended for old patient where surgery is ineffective. Cost is $700-$900 dollars.

Chronic management:

In cases of chronic joint disease, your veterinarian will work with you to come up with a comprehensive plan to best manage your pet’s joint pain. This may include: a weight loss program, physical therapy exercises, swimming, a prescription joint diet, fish oil and other joint supplements, and pain medications. Cost varies depending on the required medications.

Stem Cell Therapy: Stem cell therapy is sometimes recommended for management of healing and chronic pain with joint disease. Cost is $2,000 -$3700 dollars.

Anti-inflammatories/NSAIDS: Though anti-inflammatory medications do play a part in managing pain, they are contraindicated in acute injuries as they may inhibit joint healing long term. Ask us about other pain medication options for your pet.

Surgical Options for Cruciate Disease:

Here are some surgical options to discuss with your veterinarian to see which might be the best option for you and your pet. Regardless of the surgical technique, approximately 60% of dogs will require surgery on the opposite (good) knee in the future:

Bilateral Extracapsular Stabilization Technique (BEST Technique): This technique uses suture to stabilize both sides of the knee joint. For larger dogs, multiple pieces of suture are used to aid in recovery. It aids in stabilization of the cruciate ligaments, collateral ligaments, and generally has a 95% return to normal function. This technique allows scar tissue to form over the suture stabilizing the joint long term. This technique will fail if your dog is too active and breaks the suture or if they are poor at forming scar tissue. Cost is approximately $2,500 dollars.

Lateral Suture, Extra-Capsular Repair: This technique uses suture to stabilize the knee joint. It aids in stabilization of the cruciate ligaments, and generally has a 95% return to normal function in small dogs. This technique allows scar tissue to form over the suture stabilizing the joint long term. This technique will fail if your dog is too active and breaks the suture or if they are poor at forming scar tissue. Cost is approximately $1,800-2,500 dollars.

Tightrope Implant: These extra-articular (outside the joint) procedures utilize suture material placed under the skin but just outside the knee joint to mimic the stability of an intact cruciate ligament. The Tightrope is a suture technique that involves tunnels to be drilled through the thigh and shin bones for more accurate anatomic placement of the suture/toggle implant. This procedure has less likely hood of the suture breaking than the BEST or the Lateral Suture. This technique has a slightly higher post-operative infection rate, and does not stabilize collateral ligament damage. Return to normal function is also 95%. Cost is approximately $1,800-2,500 dollars.

Tibial Plateau Leveling Osteotomy (TPLO Technique): This procedure involves making a circular cut into the top of the shin bone and rotating the contact surface of this bone until it is level at about 90 degrees to the patellar tendon. At this angle and orientation, the knee is relatively stable independent of the cruciate ligament. A plate and screws are used to stabilize the cut in the bone. Once the bone is healed, the bone plate and screws are no longer needed, but are seldom removed unless infection occurs. Return to normal function is approximately 95%. Complications can include fracture of the bone plate, bone infection, and non-union. Cost is approximately $4,500-6,000.

Tibial Tuberosity Advancement (TTA Technique): This procedure involves making a linear cut along the front of the shin bone and advancing it forward until the patellar tendon is oriented about 90 degrees to the top of the shin bone (tibial plateau). At this orientation, the knee is relatively stable independent of the cruciate ligament. Similar to the TPLO, the cut in the bone is stabilized with a bridging plate and screws. Though the bone plate and screws are not needed once the bone is healed, they are seldom removed unless infection occurs. Return to normal function is approximately 95%. Complications can include fracture of the bone plate, bone infection, and non-union. Cost is approximately $5,500-7,000.

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