Help! My pet has Odontoclastic Resorptive Lesions – what does that mean?

The yellow arrow is pointing to a resorptive lesion just above the gumline.

Odontoclastic Resorptive Lesions (ORLs also known as Tooth Resorptions TRs) can be a really difficult diagnosis to understand. If you have been told your pet has resorptive lesisons, you have probably also been given a lot of information to process. This page is designed to help you work understand the diagnosis and its’ implications.

What are odontoclastic resorptive lesions?

In short Odontoclastic Resorptive Lesions are painful lesions in your pets where the hardened outer layers of their teeth are being dissolved. This means the tough outer layers, comprised of enamel, dentine and outer casing is being dissolved away, and results in a very painful hole in your pet’s tooth.
We call them odontoclastic lesions, as “odontoclasts” are the specific cells in your teeth that are activated to start breaking down the teeth. When this occurs under the gumline, the resorptive tooth can often start to be replaced with bone.
You may have heard them called Feline Oral Resorptive Lesions (FORLs), Odontoclastic Resorptive Lesions (ORLs) or even just Tooth Resoptions. (TR’s) Occasionally vets will even refer to them as “an autoimmune condition that affects the teeth”. All of these refer to the same thing, and they can occur in both dogs and cats. We see it far more often in cats though, and only rarely in dogs.

What causes them?

This is the million dollar question that we would all like to know the answer to. In some cases, the cause seems to be inflammation that triggers the odontoclasts to become activated and start attacking the teeth. In other cases there seems to be something wrong with the body’s normal immune response, and the body attacks the teeth instead of the bacteria. Often this occurs below the gumline, and the tooth is gradually replaced with bone.
In most cases we don’t know what causes it, but we do know that once your pet has had one tooth resorption, it is much more likely to happen again. This is particularly true in cats.

How do you diagnose Resorptive Lesions?

It can be difficult to diagnose without dental X-rays as animals hide their pain. Very rarely, we will have an owner notice that their pet is only eating on one side of their mouth, or has stopped eating dry food, or has started dropping more food than usual. Sometimes they notice a jaw “shudder”, or their pet drools more than usual. But most of the time, because our animals are so good at hiding pain, these lesions aren’t picked up until your pet is examined at the vet. If there is a lesion above the gum line, we can sometimes see it as a red exposed spot on your pet’s teeth. Other times we can see a “pit” in the enamel that is painful to touch and that our probes catch in.


This red arrow shows that the tooth is being resorbed under the gumline. The normal periodontal ligament is missing, indicating the tooth is being replaced by bone.

Still other times, we notice gingivitis or periodontal disease and recommend a dental. It isn’t until we are taking dental X-rays of your pets mouth that we pick up that there may be resorptive lesions, as the entire lesion can occur under the gumline.
Often when the lesion is under the gum, the tooth becomes replaced with bone, and the X-rays no longer show the normal periodontal ligament around the tooth. Instead the tooth root blends into the bone around it (see Green Arrows for normal periodontal ligaments.)

Types of Resorptive Lesions

There are 3 different types of resorptive lesions.

Type 1 lesions are focal, and usually above the gumline. In these cases the tooth root is usually intact, and on Xray you can see teh normal black line around the tooth root (which is the periodontal ligament). This type is most commonly associated with inflammation and gum disease.

Type 1 lesion (Yellow Arrows) The teeth show resorption in a specific round area, but the tooth root still shows an intact periodontal ligament (green arrow to the dark line around the tooth root)

Type 2 lesions involve the root below the gumline being resorbed and then gradually replaced with bone. The periodontal ligament is lost and the root can become difficult to distinguish from the bone around it.\

Type 2 lesion. The tooth with the green arrow is healthy, and you can clearly see the dark line of the periodontal ligament around the tooth root. The tooth on the right is in the process of being resorbed. The ligament is no longer visible, and the root is starting to blend into the bone around it.

Type 3 lesions are a combination of both 1 and 2 lesions. There is focal resorptions above the gumline, but the root is also being resorbed and being replaced by bone.

Type 3 lesion. The green arrow is pointing to a normal, healthy tooth, with a black line outlining the roots of the tooth. The yellow arrow is pointing to the tooth itself that is being resorbed. The red arrow highlights that the periodontal ligament is missing from the affected tooth, and the tooth roots are starting to become bone.
Type 3 lesion. The affected roots (red arrow) are barely discernible from surrounding boney tissue. The yellow arrow shows the tooth is resorbing above the gumline. The green arrow highlights a healthy tooth beside the affected tooth, with the black line of the periodontal ligament clearly visible.

How do you treat Resorptive Lesions?

This depends on the type of lesion. Type 1 lesions need to be completely removed. They are painful and cannot be removed by taking the exposed tooth away only, they need the entire root taken out as well. Type 2 and 3 can have crown amputations performed. As the root itself is already undergoing resorption and turning into bone, it often cannot be taken out and needs to be left. However in this situation, where the root is turning to bone, the root itself is not painful, and the pain resolves once the affected crown has been removed.

Does my pet really need all of their teeth taken out?

This is one of the scariest things a vet can say, but we don’t say it lightly! We almost always try to preserve as many teeth as possible.

In many cases, no, your pet does not need all of their teeth taken out, just the affected ones. But this does mean that you will need to be on the alert for recurrence. We know that once your pet has had one, they often end up with more lesions later down the track. We would usually recommend regular professional cleaning, to prevent the gum inflammation from contributing to resorptive lesions returning.

In some situations though, the best thing for your pet is to have all their teeth removed. These lesions are painful, and if your pet has advanced gum disease, or is showing other signs of on-going problems, those teeth are better out.

It is incredible how well animals do without any teeth! Cats without any teeth can often still eat dry biscuits, although some will prefer softer food. After years of pain while eating, they really do seem a lot happier and healthier without those teeth in. On those occasions when we do recommend removing all of those teeth, it is because we truly believe we will make your pet happier and more comfortable without those teeth.

Registering and desexing cats and dogs from July 2020.

In an effort to encourage responsible pet ownership and desexing of pets, the Office of Local Governments has passed legislation that imposes penalties on people who desex their pets later than 4 months for cats and 6 months for dogs.

But I am worried that will be bad for my pet?

There are certainly some situations where early desexing is not ideal for your pet’s health. See this page for some advice on when to desex your pet. Please come in and talk to us. For some pets there are definite medical reasons to delay desexing. In these circumstances, we are able to provide assistance with having the extra permit fee waived until your pet is able to be desexed. If you have any concerns, it is worth speaking to us about how we can help.

So what exactly are the new rules?

Cats:

Note: This website was last updated July 2020. For the most up-to-date rules, please go to the Tweed Shire Council website.
The new rules state that if cats are not desexed by 4 months of age, there will be an annual permit fee of $80 on top of the life time registration fee of $50 until your cat is desexed.

Dogs:

Dogs that are not desexed by 6 months of age are charged $216 for lifetime registration instead of $60.
Dogs that are a restricted breed or that have been declared dangerous will also have an annual permit fee of $195.

But that’s not fair!

In New South Wales, we have been one of the few states to have introduced lifetime registration. Until now it has been much cheaper to register your pet in New South Wales than Queensland. In Queensland they still pay an annual fee regardless of whether or not a pet is desexed).
That means it is still cheaper in NSW than QLD for most pet owners! Additionally we are one of the few states with a state based registry, rather than multiple private registration databases.
This is not a council level decision, and Tweed Shire Council are not responsible for the new rules. This is a statewide decision to encourage desexing of pets. Rest assured though, if it is not in your pet’s best interests to be desexed early, we will help you where we can.
We strongly encourage you to register your pets, regardless of when they are desexed. There can be heavy fines, which range from $330 – $5500 according to the Office of Local Government Website.

What is the difference between microchipping and registering my pet?

Microchipping involves a needle to place a small chip the size of a grain of rice.

A vet can place a small microchip under your pet’s skin – this is called microchipping. We also usually register this number in the NSW Pet Registry database (unless you specify otherwise. There are some privately run databases in Australia). But this is not the same as registering.
Registering your pet is a separate step you take after your vet has microchipped your pet. You need to log onto the NSW Pet Registry database and create your own profile, and pay the life-time registration fee. This fee enables council to keep track of the number of animals in the shire, and facilitates location of lost and stray pets.

Additional ways to prevent dental disease in your pet.

“My pet WON’T let me clean their teeth!”
“I don’t have the time to clean my pet’s teeth!”

You’re right, you’re right. Every pet is different and some pets just WILL NOT allow you to clean their teeth. Even with our fancy step-by-step guide Don’t despair and give up! Anything is better than nothing.  Every little bit you do towards your pet’s dental health counts. And you would be surprised how many cats are willing to chew a chicken wing, or eat a Greenie so this applies in part to cats as well.

You want something that holds its shape while being chewed. This can come in 3 distinct categories: food, treats, and toys. Regardless of the category, the basic theory is if it holds its shape while being chewed, it can wipe the teeth clean – a little like when we bite into an apple. 
Alternatively there are some treatments that may be of limited use as well. Nothing is as good as a professional clean, but every little thing you do helps!

1) Food

In general dry food is better than wet food, as it doesn’t cake around teeth, but certain dry foods are specifically designed to clean teeth while being eaten. The following ones arr complete diets – your pet doesnt even need anthing extra, and they are available for cats and dogs:
a) Hill’s T/D
b) Royal Canin Dental
c) most other “dental” labelled diets (although they are not necessarily complete and balanced, an may not be as effective a the above

2) Treats 

When it comes to treats, anything that they have to chew on is good for teeth – usually better at cleaning back teeth than front ones though, so you may need to think about what to do about front teeth. They also add in extra calories – and those calories do count! If your dog gets extra treats, they need less food at meal times. ) Raw Bones  – bones are a double edged sword. While great for cleaning teeth, they can also crack teeth. Your best best is large marrow bones, too big to eat, but big enough to chew on.  Avoid all forms of chop bones, as they are sharp and can be small enough to swallow and cause troubles in the stomach. Bones are also high in fat so should be avoided for dogs with sensitive stomachs. 
b) Chicken necks and wings. These can be fatty so be aware of the calories you add into your dog’s diet.
c) Carrots, Apples, other sweet crunchy veges – some dogs love them, others hate it.
d) Pigs Ears, pig’s snouts, pig trotters – all good for chewing on.
e) Roo tendons and tails
f) Greenies – these contain chlorophyll, which can potentially kill bad breath bacteria (and cats love these!)
g) Dentastix and other assorted dental chews. There is a whole range out there. Go nuts!
h) Ice – crunching on ice seems to be something that some dogs love doing. Mad, but we love those labs & staffies anyway!

 3) Toys

When it comes to toys, anything that your dog can chew on, wihtout chewing bits off, is perfect. There are some specially shaped chew toys out there that are specifically designed for cleaning teeth. Some even have a hidey-hole to place dental treats so you can encourage your pet to chew the toy.

4) Treatments 

There are some additives for water, gels for killing bacteria in the mouth and other various dental treatments. These are of limited use. They may kill bacteria and temporarily freshen breath, but they cannot remove tartar or plaque with any effectiveness. However if this is all you can convince your pet to take, they are better than nothing if used regularly!

How to clean your pet’s teeth

(A step-by-step guide for the reluctant pet… or owner!)

Wouldn’t it be great if your pet had opposable thumbs and cleaned their own teeth? You’d save so much in vet bills, their breath wouldn’t stink, they’d make less mess eating, and be less fussy with their food.
Life would be bliss!

Firstly, lets get the bad news out of the way. Not all pets, no matter how hard you try, will let you clean their teeth. And that does not make you a bad owner, nor does it mean you have a bad pet. There are a few tricks you can try to gradually introduce teeth cleaning but in the end, every pet is unique. We get it. If this page is not going to help, you may find these alternative ideas helpful.

Even worse, some pets have such bad jaw alignment or overcrowding issues that even if you do clean their teeth regularly, they can still end up with teeth problems. We understand.

But despite this, it IS actually worth trying to clean your pet’s teeth for them. Here are a few tricks we have learned over the years to help

1) Don’t open your pet’s mouth.

This may seem counter intuitive but most pets hate having their mouth opened (we think they are anticipating a pill!) Instead, lift their lip at the side and make them ‘smile’ a little. Technically we mean don’t open their jaw, but DO open their lips. This picture demonstrates the idea brilliantly.

2) Start with a wet rag, wash cloth or paper towel, the wetter the better!

Many animals love being smooched around the mouth/cheeks. And it is surprising how many don’t mind their teeth being rubbed. Rub the outside of their back molars to begin with. Your aim is to rub away the stuff that causes the “furry feeling” in our human mouths.

3) Reward them!

Lots of pats!

4) Aim to do this 1-2 times weekly.

At least until you have a reasonable routine that your pet doesn’t seem to mind too much This may take a few months. If you have kept this up, remember to reward yourself too! Owning a pet can be hard work sometimes, and you are doing great!

5) Work up to cleaning all around all of the teeth.

That means the insides, outsides, tops or the bottoms of the back molars, but also remember to clean both sides of the front teeth! All of this is still just with a wet rag.

6) Introduce pet-flavoured toothpaste.

Liver; pate; chicken; cheese; beef – there are a lot of options! Just don’t use human toothpaste. Our pets don’t spit the toothpaste out, and there is too much fluoride in human toothpaste for them. Additionally, our artificial sweeteners can be toxic to our pets.

7) Introduce a toothbrush.

Once they are enjoying the toothpaste, and the rewards afterwards, NOW is the time to introduce a toothbrush. It can take months or even years to get to this point, but be assured, even wiping your pet’s teeth with a wet rag for a year is better than nothing when it comes to teeth cleaning. Again, with the toothbrush, go right back to the very beginning – you don’t need to open their mouth, just lift their lip. And start with a small toothbrush. A finger brush is ideal. Use the toothpaste flavour that they liked the most, and plenty of water.

8) Brush with a toothbrush the whole of their mouth.

By this stage they should be well adjusted to you handling their mouth, and the taste of their toothpaste. 

9) Aim for 1-2 times a week.

These are lofty goals. If you can manage to clean your pet’s teeth daily, go for daily. If your lifestyle means you only get around to it once a month, do it once a month. Anything is better than nothing when it comes to cleaning your pet’s teeth.

10) Reward both yourself and your pet if you have gotten to this point!

We recommend a trip to the beach, or a large open area. Or maybe your cat’s favourite tuna and a night of jazz for you both. To each their own, but you both deserve it. Well done!

Parasite protection for your pet

Sample plans for puppy/dog prophylaxis.

There are 2 main options when it comes to making sure you have all of your dog’s medications under control. Along with an annual trip to the vet, you will also need to give your pet medication on a monthly or a 3 monthly basis. We have given a sample of each protocol below. There is usually little in the way of price difference between the two regimes, and both are quite safe, so it really comes down to personal preference. Is it easier to remember regular, monthly treatments, or are you better off with just 3 treatments a year (and a reminder on your phone calendar)?

3 Monthly

  1. Annual health check, vaccination and heartworm injection at the vet clinic.
  2. 3-monthly treatment for fleas and ticks: Bravecto.
  3. 3-monthly treatment for worms.* For example: Drontal, Canex, Popantel, Cazitel. It is also safe to use Milbemax and Interceptor Spectrum as well.

Monthly

  1. Annual health check and vaccination at the vet clinic.
  2. Monthly treatment for heartworm, worming fleas and ticks. For example: Nexgard Spectra*, The Big 5 (which consists of 2 different medications).
  3. Additional tapeworm tablet as required every 3-6 months.* (Nexgard Spectra does not cover tapeworm).

OR

  1. Annual health check and vaccination at the vet clinic.
  2. Monthly treatment for fleas and ticks: Nexgard. 
  3. Monthly treatment for heartworm and worms.* For example: Milbemax or Interceptor Spectrum

FAQS:

Why aren’t there any spot-on options?

We generally find that spot-on treatments are not as effective for fleas and ticks as oral treatment. Additionally, spot-on medications that treat intestinal worms usually don’t treat tapeworm, and require extra tablets. They also overlap with other medication combinations and you usually end up worming or treating your dog for fleas with two different products. This is not usually harmful, but it does seem like a waste of money.

What about other combinations?

There are a lot of other combinations out there. We have not included flea and tick collars for example, as they are rarely effective against fleas, ineffective when taken off for swimming and bathing, toxic to animals in the waterways and should be avoided if children are handling your dog. However there may be situations where this is your best option. There are also ways to mix and match — particularly if your dog does not tolerate a specific medication. As long as all of the parasites (fleas, ticks, heartworm, and intestinal worms) are covered, most of these medications can be used as required. There are some combinations to be aware of, so check with your vet before varying from one of these recommended programs.

*What was that asterisk about?

Some pets may require an extra strong dose of praziquantel to treat zipperworm (spirometra) if they are ‘hunters’. Lizards, geckos, snails, and frogs can transmit zipperworm if they are eaten. Speak with your vet if you feel your dog may need extra medication.

At what age should I desex my dog?

At what age should I desex my dog?

This is a complicated question. If you are thinking about breeding from your dog, you should not desex them, as it is not a procedure we are able to undo. Please get a vet to examine your pet and make sure they are suitable for breeding. For more information about a dog’s reproductive cycle, please click here

There are several options when it comes to desexing, and as is so often the case, this is because there is no single right answer.

As a general rule we recommend desexing by 6 months of age. We try to aim for before your dog’s first heat where possible (although there are many exceptions we will go into shortly).

Benefits of desexing female dogs

The biggest reason for this is to prevent unwanted litters, and help limit the number of pets who are in shelters and foster homes. Our local Friends of the Pound does a fantastic job of re-homing unwanted and surrendered dogs but it would be so good to see no unwanted animal. Our local council has also put a financial incentive on this – dogs desexed before 6 months of age are much cheaper to register. In 2020 this means a $60 lifetime registration fee rather than a $260 fee (although please look to the council page for the most current fees, they are prone to change).

Additionally, the desexing procedure has a far quicker recovery time in a young patient, with less complications, and a shorter anaesthetic. If we can safely prevent extra pain and recovery time, we will. This is particularly significant in female dogs.

There are also some great health benefits to desexing a female dog by 6 months of age. It almost completely reduces the risk of pyometra, uterine cervical and vaginal cancers and mammary cancers – most of which are serious, and common in undesexed females. Finally, desexing (by 6 months) has been linked to a longer lifespan in female dogs. This seems like a great advantage.

There are also some benefits to your dog’s behaviour. Desexing decreases the risk of roaming and escaping, especially when your dog is in season. It can also reduce some of the aggression behaviours often seen when a dog is in season.

Downsides to desexing female dogs

The biggest downside of desexing early is obesity, but it can also predispose to some issues such as cruciate disease, particularly in breeds that already have a predisposition to this. In giant breeds, there is some evidence that desexing is better postponed until skeletal maturity (about 1 year of age). You should discuss this with your vet at your puppy vaccination appointments.

Early desexing in female dogs

In some situations we may desex a dog as early as 3 months of age. This is considered ‘early desexing’ and although the procedure itself is quite safe, we generally only recommend this in specific circumstances.

Later desexing in female dogs

Dogs desexed after their first heat (around 12 months of age ) have an increased risk (comparative to desexed at 6 months of age) of mammary cancer, but this risk may be worthwhile in dogs predisposed to orthopedic disease such as hip dysplasia and cruciate ligament disease.

Even if your dog has been used for breeding, there is a benefit to desexing her once she has had her last litter. As she gets older the risk of complications with litters increases. Additionally, the risk of pyometra also increases. Having your female dog desexed later in life will help prevent unnecessary pain and suffering.

Benefits of desexing male dogs

Male dogs have a significant decrease in testicular cancer, prostatic disease and hyperplasia. They also have a decrease in aggressive and territorial behaviours, and make your male dog less likely to escape and go looking for the nearest female on heat. Desexing male dogs also shows an increase in lifespan.

Additionally by desexing your male dog you are also contributing to reducing the number of unwanted litters. You may not have direct responsibility for the puppies, but your dog will want to procreate just the same.

Downsides to desexing male dogs

These are similar to the risks in female dogs – the biggest one being obesity. Similarly to female dogs, orthopaedic disease such as cruciate ligament disease, and hip dysplasias may increase if the male dog is desexed before skeletal maturity (about 1 year of age).

So at what age should I have my dog desexed?

As you can see, there is no “right” answer for any specific dog. We can desex your dog at almost any age, and the benefits and risks will vary for each dog. It is a good idea to discuss all of this with your vet to find a time that is appropriate for your pet.

Reproduction in Dogs

At what age will my dog first come into season?

Most dogs reach sexual maturity and begin to cycle around 6 months of age, but this can vary in individuals. Large dog breeds often reach maturity much later – sometimes even as late as 12 months, while smaller breed dogs can come on heat as early as 4 months. Unlike other species, dogs are not specifically tied to seasonal cycles, and can come on heat at any time of the year, although it can take several years before their heats become regular.

What does ‘on heat’ or ‘in season’ mean?

Also known as oestrus*, ‘coming on heat’ or ‘coming into season’ is the way we describe a female dog becoming ready to mate with a male dog and reproduce. It is a 2-4 week period of time when your female dog’s hormones are change dramatically, and occurs approximately every 6 months (although this can vary). There are 4 stages:

a) Proestrus

This is the preparatory stage when the female’s body begins to change. Their vulva becomes swollen, and you may notice a blood-tinged discharge from her vulva. This not always obvious because she will also lick her vulva frequently – and in some cases will lick before you notice a discharge. In other dogs, you may find yourself needing doggy nappies to contain the flow and prevent her making a mess. Every dog is different. You may notice her behaviour changes and she becomes a little clingy. In hormonal terms, the female dogs oestrogen levels begin to rise, peak slightly and begin to decline. This stage lasts around 9 days in a dog.

b) Oestrus.

This stage is the receptive, ready to mate stage and lasts around 9 days. There is less discharge in this stage, but the female is receptive to other males. She will often urinate more than usual and you may find her behaviour becoming aggressive towards other females and just behaving “out of sorts”. This is the most fertile stage and ovulation occurs within 2-3 days of this stage. Both progesterone and oestrogen decline during this phase. Female dogs may be more likely to escape and wander in search of a male, and male dogs are more likely to break INTO your backyard – so dont leave her unsupervised!

These dogs have mated – and are ‘tied’ together. This can last for up to two hours, and is perfectly normal.
c) Dioestrus.

This period lasts about 2 months, as your dog’s body returns to normal, (or begins a pregnancy.) Progesterone levels rise, whether your dog is pregnant or not, but the vaginal discharge will disappear and her vulva should return to normal over this period. As both pregnant and non-pregnant dogs have a rise in progesterone, we often see a “false pregnancy” in dogs who are not pregnant. These dogs can show weight gain, mammary development and even nesting behaviour, despite not being pregnant.

d) Anoestrus.

This is the period of time when your dog is not on heat. Behaviour, vulva and discharge should all return to normal, and this period can last from 3-6 motnhs.

How often will my dog come in heat?

This can vary from dog to dog. Smaller dogs can come into heat every 3 or 4 months, while giant breed dogs (think Great Danes) may only come into heat once every 12 months. In general, the average dog usually comes on heat every 6 months.

For more information about when you should desex your dog, please CLICK HERE and see our page on “At what age should I desex my dog?”

Separation Anxiety

Separation anxiety is becoming more and more common. As our pets become a part of the family they become more attached to us and it can become quite stressful in some circumstances when you need to go to work and leave your pet behind.

Our first step in managing separation anxiety is always behavioural modification and training. Medication is a last resort, and not always helpful. Here are some helpful tips that may help you manage your pet’s separation anxiety.

Step 1 – Your behaviour

To start with, ensure your arrivals and departures are not a big deal on your side. That means remaining calm, and not making a big fuss over your dog. This can be especially hard when you return home, because it is easy to want to spoil your dog. Try to resist the temptation, and save the special pats and attention for a little later on. When you first arrive, don’t turn it into a big event.

Step 2 – Conditioning

Condition your dog to becoming used to the usual “cues” that you are about to leave. Many people notice that their dog starts to become anxious before they even leave the house. Dogs notice when you pick up your keys, pack your bags, put on certain clothes, and even put make-up on. It can be helpful to practice this, without leaving the house, so that your pet becomes accustomed to this routine.

As your dog becomes more accustomed to this, you can extend the conditioning to stepping outside the door briefly and coming back in again – each time not making a fuss out of the event. It is not time to reward or pat your dog – this is just a normal event, you are leaving and coming back.

Step 3 – IQ toys

Make use of the IQ toys available. There are many toys now available that require your dog’s attention and some thinking effort. There are puzzle feeders, snuffle mats to play hide-and-seek with, and toys that require persistence to retrieve food from, just to name a few. Start using these while you are actually at home, because often severely anxious dogs will not eat unless their owner is present. In some cases you may find you can transition to your dog’s entire daily food requirements being provided by a game.

Step 4 – Crate training

Crate train your dog. Crate training is actually a very effective way of giving your dog a “safe space” to go to when they are feeling nervous or anxious. It can take a bit of time, but start with a large crate in the family room with some clothes/blankets that smell comforting to the dog. That may mean they are your clothes, but try to use something that already belongs to your dog!
Start by leaving the door to the crate open, but making the crate the “treat den”. When you give your dog a treat, toss it in the crate. Make the crate a place of warmth safety and comfort. Try using a command such as “bed” or “crate” before tossing the treat in. You can start feeding in the crate as well – and work towards shutting the door while your dog is eating, then opening it again after the meal.

Get your pet gradually used to longer and longer periods inside the crate, with the door shut but you in the same room, before leaving your dog in the crate for long periods alone. Overnight is a good choice of first “long period” alone – you are still in the house, and your pet is just in a safe, fun, warm place.

Step 4 – Exercise

Exercise your dog before you leave them for any length of time. Try and early morning walk or play before work. It may seem simple, but making sure your dog has used up all their excess energy before confining them to the house can help control some of the more exuberant behaviours in some situations. Similarly ensure they have been toileted before being left.

Step 5 – Over the counter remedies

There are several over the counter remedies and supplements that you do not need to see a vet for, which you may find very helpful. Searching online for aDAPtil, Zylkene or Complete Calm may act as starting points. These products can be of some benefit, especially in milder cases, and some people have found this is all they need (along with behaviour modifications).

Each dog is unique and will have different triggers and causes for the separation anxiety. One thing that needs to be mentioned is that getting a companion dog does not necessarily solve the problem. Some dogs seem to be bored, and a second dog is simply someone else to destroy the house with. Others can be so people-centric that they do not rate other dogs as important or interesting, and continue to bark or whine. Each situation is unique however, and so making a long-term purchase such as a new dog, without any guarantee of success is a risky thing to do.

But all this takes time… and my neighbours are complaining, and my dog is destroying the house, and I can’t take several weeks off work to train my dog. What should I do?

Unfortunately there is no quick fix solution. Even behavioural medications can take several weeks to “kick in”. If you need an immediate solution while you are training your dog, you can consider options such as Dog Safari, doggy daycare, a pet sitter, a friend or relatives house for the day, or even (in some workplaces) you may be able to ask to bring your pet to work. If your dog is destroying your house, while you are working on desensitising them, it is worth confining them to the garage, bathroom or laundry so the damage is minimised. We do not recommend confining them to a crate without a gradual introduction, as the crate needs to become a “happy place” before it will be effective in a situation such as separation anxiety.

Over-the-counter treatments

As mentioned before, there are some non-medical treatments that some people find help with separation anxiety. These include things like aDAPtil (a Dog-Appeasing-Pheromone) that comes in a collar or a spray and is designed to help your dog find his or her happy place. There is a milk protein marketed as Zylkene which some people have found helpful with separation and generalised anxiety, and there are several herbal calming supplements such as Complete Calm that can be of limited use as well.

Be very careful using essential oil diffusers as calming treatments, as these have been linked to toxicity, and the jury is still out on how safe they are. There are several conflicting reports on which oils are safe and which are not safe. Lavender seems to be generally reported as safe, but if your dog is sneezing or reacting to it in anyway, please avoid using it. In general we recommend avoiding essential oils unless you have spoken to your vet first.

Medications

While medications are usually a last resort, if you are committed to behavioural modification, in some situations they can be used as an aid to training. Speak to your vet about your situation and find a plan that is right for your pet. Every dog is different and will need to be assessed and treated as an individual.

Coronavirus and Pets?

You may have heard a bit about COVID-19 and pets in the media. We are still learning, as the situation unfolds, but we do know a few things about COVID-19 and your pets.

Dogs

The doggy coronavirus (Canine CoV) that we occasionally vaccinate for in puppies is completely different to COVID-19. It is not related to any form of illness in people. It does not spread to people and it is not caught from people. It is a virus that causes vomiting and diarrhoea in puppies only (and in most older dogs it causes no illness at all).

The few dogs that have tested positive to COVID-19 have shown no signs of illness.

There is currently no evidence that people can catch COVID-19 from dogs, but we strongly recommend practising good hygiene with your dogs. Wash your hands after handling and avoid face kisses!

Cats

Unlike dogs, cats can catch COVID-19 from humans and it can make them sick. This includes large cats such as tigers!

If you have tested positive to COVID-19 you need to remain isolated. Given that cats have the potential to become unwell from you, this includes being isolated from your cats! If you are in a house where someone else is able to care for the pets, try to avoid contact with your cats, and have someone else care for them. If there is no-one to assist you, try to minimise close contact with your pet. That can be hard when they are your best friend, so try to wash your hands thoroughly, avoid kissing, sneezing or coughing on your pet as much as possible, and discourage them from licking you. Please don’t use hand sanitiser or disinfectants on your pet – these are toxic to pets.

We have no evidence that people can catch COVID-19 from cats at this stage. If you are practising social distancing and your cat is kept indoors, your cat will likely remain healthy as well. This means you should not need to worry about catching COVID-19 from your cat if your cat is kept indoors.

Ferrets

Ferrets have been infected with COVID-19 – but this was by deliberate exposure to high levels of the virus. So far we have not seen human to ferret transmission, but just in case, practise similar hygiene protocols as you would with your other pets. Wash your hands, avoid sneezing or coughing on your pets, and discourage licking and kisses from your pet.

By following some simple precautions, we should be able to keep our pets healthy – as well as ourselves.

Chocolate Toxicity Calculator

Remember, this calculator is a guide only.

And please, dont feed your dog chocolate and think that it is safe because “the calculator said it was”.

All chocolate has the potential to be toxic – and every pet responds differently. Your safest option is to feed your dog liver treats instead!

Dog Toys!

So, you want to spoil your pet rotten? And have been told to avoid various kinds of toys for various reasons? What is a safe toy for your dog?

As vets, we see toys causing two main types of problems:

a) The toy is too easy to break, and ends up wedged in your dogs mouth, oesophagus, stomach, intestines, or creates other problems coming out the other end.

b) The toy is too hard (or thrown too fast) and can damage your dog’s teeth.

So how do you know if a toy is safe?

The answer to that is actually surprisingly difficult. Every pet is unique, and a toy that works really well in one dog may be too easy for another dog to tear apart and swallow. The best way to be certain is to monitor your pet while they play with any new toy. There are however some definite rules about what not to use as a toy:

a) Avoid anything made of long string or rope. Long fibres, including toys attached to elastic (especially cat toys) are the absolute worst thing to allow your dog to eat. They can cause a linear foreign body which means it causes not just one point of blockage in your pets intestines, but multiple points of injury. Additionally, many rope toys are designed for tug-a-war, and most people find this possessive type of behaviour something worth discouraging.

b) Hard projectiles have the potential to damage your dogs mouth. Most frisbees and balls have some flex and give to them. Be wary of any ‘toy’ that does not have any give in it. That includes sticks and stones. It sounds silly, but these are not toys, despite the fact that some dogs like chasing them. Stones can crack a dog’s teeth, and fractured teeth are both painful and expensive. Sticks can lodge in your dog’s mouth, splintering off and causing pain, discomfort and bad breath until they are finally located.

c) Anything your dog can tear into small pieces. Teddy bears, hollow rubber balls and a variety of other toys that your dog can dismantle can be swallowed and risk causing a blockage.

Christmas treat ideas for dogs

Wondering what to do for your pet this Christmas? Confused about which treats are safe and healthy? Perhaps worried about organic dog food? Or pondering whether your cat should be vegan? Or just desperate to know how to avoid emergency vet trips on Christmas day? Read on!

Treats for dogs at Christmas?

Lets get this out of the way. Diet changes frequently cause gastric upsets in dogs and cats. Pancreatitis, diarrhoea, vomiting – the whole works. And it is the last thing you want to see at Christmas.

Often pancreatitis (a life threatening sore tummy) is caused by too much rich food. We know you love to spoil your pet, but perhaps at Christmas, when your regular vet isn’t open, stick to treats you already know they love. The ones that wont upset their tummy. And keep it in moderation!

Try to avoid the following

  • Bones -especially ham bones. Often fatty, ham is high in salt. Frequently cause pancreatitis. Not to mention obstructions from sharp bones, cracked teeth, etc. Bones can be really high risk treats. Avoid.
  • The fat from the ham – Most common cause of dogs in hospital at Christmas. High in salt, the fat is too rich and causes an inflammatory pancreatitis. AVOID
  • Sausages from the BBQ – what dog doesn’t love the left overs? The fat, the sausages themselves, the off cuts of the steak? All of these are high risk treats known to trigger pancreatitis. AVOID
  • Seafood – and seafood off-cuts. While lower in fat, seafood (particularly left overs) has a higher chance of dangerous levels of food poisoning contamination. Not to mention the shells of both prawns, bugs, and shellfish can cut your pets stomach and intestines! AVOID

Alternative gift ideas for pets?

 Your dog will love attention more than anything. Plan to include them in the family outing. Take them too the beach, or the local creek. Give them a car ride, or an extra special pat. make a ceremony or a game out of meal time. Using the same meal you can play hide and seek!

Some dogs enjoy toys too. Be careful with toys – see our page on TOYS for advice on what toys can be harmful. Most good quality toys are fine unless your dog is one of those dogs that destroys everything. If your dog is one of those, be extremely careful!

Small amounts of their regular treats are probably the best thing you can do in terms of food at Christmas, but even the most food orientated dog will appreciate attention and being made to feel special!

Storm Advice

Does a storm phobia send you and your dog crazy during a storm? Here are some great tips on keeping your pet calm during a storm. At Tweed Coast Vet we understand summer can be a time of constant stress, worrying if there is a storm coming, and not knowing if your pet will still be in the yard when you get home.

 

 

 

 

During storm season be prepared to keep an eye on the radar to watch for storms. If you and your dog are prepared you have a better chance of weathering the storm.

 

 

Sound Proof Den During a Storm

 

Try a sound proof den to give your dog a safe place to retreat during a storm. Dogs feel secure in dens, and during a storm they often want to feel secure and safe.

 

 

 

 

 

A wardrobe will make a great den during a storm! And it smells like you! But it is best to get your pet used to using the wardrobe when there is no storm around too.

 

 

 

 

Pheremone sprays and homeopathic drops for storm phobias in dogs

 

Often dogs respond positively to the pheromone sprays and collars such as Adaptil during a storm. They are associated with happiness, calm and security. Homeopathic drops can also be used to great effect- ask us at the Tweed Coast Vet about some of your options.
 

 

 

 

In severe cases there are prescription medications available for dogs with storm phobias. We don’t like to use these, but we understand sometimes we have to. TCVet would like to remind you that all medications have some risk, especially with repeated use. In the case of storm phobia medications, they can often take about 2 hours to work, so often unless you get in early they are not much help.

 

 

 

 

When using storm drops and pheromones sprays for storms in your pet remember they will often need to be re-administered. Unlike with the prescription medications, this is actually a great idea during the storm, as it can act to keep your dog calm.

 

 

When should I protect my pet against paralysis ticks?

When is “tick season”?

In our area (Far Northern Beaches NSW and South Eastern Gold Coast) paralysis ticks are found all year round. It may surprise you to hear our peak tick season starts in July! That’s right, mid winter! That’s when we start to see the tick cases coming in. They will continue to come in year round, but they start to slow down in February. We also have bush and cattle ticks, which while annoying are not usually dangerous, so for the rest of this page we will be referring to paralysis ticks.

What protection should I use?

We currently recommend Nexgard, Bravecto or Simparica for dogs. Since the introduction of these products we have seen a marked decline in the number of cases we see in the clinic each week. Most of the cases we now see are either not on prevention, or have missed a dose.

Cats remain a lot harder to treat. For cats, the Bravecto Spot-on lasts for 3 months, and is one of the better treatments available.

If you are unable to use either of these products for any reason, there are other treatments available, such as spot-ons, or tick collars. While find they aren’t as effective, they still provide protection, and any protection is better than none! And no matter what product you use, we recommend daily searching your pet for ticks.

How do I search my pet?

Paralysis ticks can be hiding anywhere on your pet. This classic photo is a reminder that we mean that literally. The most common places to find ticks are around the head and neck area, but we recommend a daily all over check. When you run your fingers through your pet’s coat you are feeling for a small bump – as small as a pin head, or as large as a little finger nail.

Start by searching between toes and under toenails. Walking your fingers backwards through the coat slowly, work your way up the tail, both back legs and then over the rump. You will have to do the same for your dog’s underside. Check around vulva/penis areas and under the tail.

Continue walking your fingers through the coat backwards. Work your way up the front legs one at a time. Concentrate the most of your time on the shoulder and neck area, going over this area very carefully as the thick ruff in most dogs, and folds of skin can mean this is a tricky area to search. Remember to search inside, outside and along the edges of your dog’s ears. Search around eyelid margins and lip margins. Run your fingers backwards through coat under chin.

Even with a thorough check like this, ticks can be easy to miss. If you suspect a tick, even if you cant find one, bring you pet in. At the clinic, we never rely on one person’s check -we know how easy it is to miss the little creatures! We usually have some combination of either 2-3 staff members run a tick check, clip the entire coat, as well as using a quick tick kill product – like a tick bath. In some situations, all we find is the crater left behind by the tick! Paralysis ticks are unique in that they leave a crater behind when they drop off or are pulled off

Ticks have several actions on your pet. They are mostly found around the head and neck area have a local paralysis effect, so if they are on the head and neck one of the earliest problems that can develop is the inability to swallow properly. Unfortunately this can be hard to detect, and extremely dangerous. This can cause regurgitation and even  accidental aspiration of food. That means unexplained vomiting can be one of the earliest symptoms of a tick bite.

Most animals will usually develop a floppy paralysis as well. Often this will start in the back legs. Collapsing in the back legs, having trouble walking, walking with a wobble, dragging back legs – all of these can be indications of a tick bite.

Ticks can also affect the ability of your pet to breathe. This is a big part of why the paralysis ticks in our area are so dangerous. The muscles that control breathing are affected by the paralysis tick, and  your pet struggles to even take a breath. This can become critical and can be complicated with aspiration pneumonia when your pet hasn’t been swallowing properly.

Treatment 

Generally, once an animal starts to show symptoms of tick paralysis it will need to be treated. We all hear the odd miraculous story, but when it comes down to it unless your pet gets the anti-serum it will usually die. Not a risk any of us at Tweed Coast Vet will ever recommend.

The anti-serum is collected from specially bred dogs that have an immunity to ticks. This means it can be quite costly. If cost is concerning you when it comes to treating your pet, please come in and see us. We will do everything we can to communicate what needs to be done, and what is in the best interests of your pet so you can make an informed decision. We even have payment plans available.

We usually recommend clipping an animal – because unless your pet is bald it can be really hard to see if there is more than one tick on your pet!. We also recommend some form of “quick kill”: either a bath or treatment that will kill any remaining ticks that we may have missed instantly.

We usually administer some medication before the tick serum. Sometimes this is a simple sedative to keep stressed animals calm while the tick serum is administered. Sometimes we add in something to prevent them from reacting to the tick serum, as these reactions can be dangerous. We treat each case individually and we will discuss this with you.

The tick serum  itself is administered quite slowly – sometimes over several hours. This goes into a catheter in your dog or cat’s front leg (usually!) As this can make them temporarily more sick, we monitor your pet closely while this is given.

Most dogs need to spend a couple of days in hospital recovering. They cannot eat or drink, they are prone to relapse when excited or agitated. Some animals end up on IV fluid therapy. This will depend on how long they are in hospital, their age, hydration status, and how long they have been sick for. We will discuss each stage of your pets care with you.

Specialist Care

Sometimes some pets need specialist care. If their breathing is compromised badly enough, they can end up on a respirator – a machine that can do their breathing for them. If this is the case for your pet we will usually send them to the specialist centre. This is because once they are on a respirator they need 24/7 care. Unfortunately we have neither respirators, nor the ability to provide 24/7 care at  Tweed Coast Vet but if your pet needs this we will let you know as soon as possible and help arrange for a transfer.

Recovery

Once a pet is able to swallow and keep food down safely, we are usually are happy to send them home. This can take a few days time, though and sometimes improvement can be slow. We like to give daily updates, but sometimes there is little change to report, which can be frustrating.

At TCVet we understand this, but sometimes it is best not to visit your pet during recovery, as excitement can worsen things for them.

This applies once they have come home too. The tick toxin can have a direct effect on the heart muscle itself and too much exercise or excitement can cause a relapse up to several weeks after recovery.

We recommend taking things easy initially. Small meals, and toilet breaks instead of actual walks. We encourage a gradual return to normal walking behaviour over the next few weeks so that your pet sould eventually be as good as new.

One of the worse things to see though is a second tick on the same dog. It makes treatment even riskier as they are more likely to react to the serum. When you get your pet home, make sure your pet has some form of prevention!

What to expect from surgery at Tweed Coast Vet.

Your pet is in safe hands at Tweed Coast Vet. With one surgical theatre for major procedures, and an additional two for minor procedures we are able to take care of almost all of your pets needs. All of our surgery rooms are well equipped with adjustable tables, fluid pumps, and equipment to monitor breathing and heart rates, blood pressure and temperature. We even have an ECG and the ability to monitor cardiac patterns.

We almost always like to have met and examined your pet’s overall health before any surgical procedures. Occasionally we can do this on the same day as the surgery, so call us if your pet hasn’t seen us in a few months.

What to expect for Routine Surgery

For most procedures – eg speys, castrations, lump removals and wound repairs – your pet is only with us for the day. We ask you to withhold food overnight before the procedure and drop your pet off in the morning. We usually arrange a time that suits you that afternoon to pick your pet up.

We recommend intravenous fluids with all procedures. However, in young pets and short procedures, if cost is a specific concern and your vet considers your pet to be in general good health, we are able to discuss other options.

Most desexing procedures (speys and castrations) have no stitches to be removed. The sutures are placed just under the skin, and dissolve slowly over time. This can form a small hard lump at the site of the surgery. If you are worried about the size of the lump, or the lump is not hard please call us.

For lump removals and wound repairs, we often put external stitches in to avoid that small lump. This does mean you will need to return to visit us 10 days after surgery to have the stitches removed. This visit is of no charge and allows us to check that everything has healed well.

As for those cones (Elizabethan collars) you see some pets wearing after surgery? We are able to provide them (although you will need to decorate them yourself if you want them as pretty as that sunflower above!) If your pet is prone to licking and chewing at themselves, we strongly recommend them. We often find pets don’t need them, but in some situations it is essential. If we notice a pet licking at their wound in the hospital after surgery, we will raise this with you before your pet goes home.

Femoral fracture repair

What to expect in non-routine procedures.

We perform a lot of “non-routine” surgeries at our clinic. This includes removing tennis balls from stomachs, repairing broken bones, fixing torn ligaments, and removing tumours from your dogs abdomen. If we tell you your pet needs their spleen removed, or their cruciate ligament repaired, we would consider it a non-routine surgery (even though we do it all the time).

These surgeries are “bigger” than routine surgeries, in the sense that they take longer and your pet is under anaesthetic for more time. Sometimes we can send your pet home the same day but often we will keep them in over-night. We do not have 24-hour monitoring, but we do have someone checking on them after hours to make sure all is well. We often keep your pet on fluids overnight as they were under anaesthetic for a long time. Keeping them in hospital also allows us to use some stronger pain relief if they need it. Crucially though, it also keeps your pet confined. If your pet goes home after a big procedure and jumps on the bed or plays with your other pets, it can risk damaging the still healing surgical site.

If your pet is highly anxious we try to take this into account. If it is safe to do so, we will send your pet home. We know every pet is an individual, and every home situation is unique, so we take this into account with every surgery. This also applies to those cones (Elizabethan collars).

If for some reason your pet does require 24 hour monitoring after a surgery, we are able to send your pet to the emergency after hours clinic to be more closely monitored.

Bigger procedures like this almost always have external stitches and are checked 10 days after surgery. There is no extra charge for this follow up visit unless further medications are required.

Cat Vaccinations

CORE VACCINATIONS (These make up an F3 vaccination)

Panluekopenia 

This virus has also been called ‘cat parvo’ in the media. Similarly to parvo in dogs, it causes bloody vomitting and diarrhoea in cats. It also wipes out the cats immune system. Fortunately we see it rarely as it is preventable simply by vaccinating your pet.

Calicivirus 

Calicivirus and herpesvirus together form what is known as cat flu. The symptoms are usually a discharge from the eye and nose. They can also cause fevers and make a cat inappetant. The biggest problem however is that once a cat is infected they are often infected for life. The flue like symptoms come and go, depending on how run-down your cat’s immune system is. They can continue to be a source of infection for other cats in the household as well. We recommend vaccinating cats that are infected as it can frequently decrease the symptoms and severity of the flue outbreaks.

Herpesvirus

Herpesvirus also causes cat flu, but unlike calicivirus, it can also cause ulcers in the eye and the mouth which can be hard to treat and difficult to resolve.

 

NON-CORE VACCINATIONS

Feline Immunodeficiency Virus (FIV)

FIV is transmitted through fighting and mating.  Desexing will prevent the latter, but vaccination is still recommended when cats roam outdoors and have the potential to get into fights.  The primary course is 3 injections 4 weeks apart, followed by annual boosters.

Dog Vaccinations

At Tweed Coast Vet, Cabarita, we have tried to keep things simple for you. We keep up-to-date with the latest research and guidelines released by the Australian Veterinary Association, so that you don’t have to. This page explains about preventable diseases in DOGS.  For information on cats, please check out the CAT VACCINATION page. We have also provided a recommended Puppy and Kitten Vaccination Protocol with our usual recommendations. Please note these may change according to your personal circumstance.

DOGS:

In-line with the current Australian Veterinary Association guidelines we offer an annual KC vaccination and a triennial C3 vaccination, which combined form the same as the old C5 vaccinations. This is the minimum requirement for entering boarding kennels. This vaccination combination will cover parvovirus, distemper, hepatitis, parainfluenza and bordatella. Our area is particularly prone to kennel cough

CORE VACCINATIONS

Parvovirus is a disease you hear about in the media a lot. It is frequently fatal, and when it is not fatal it is painful, long and drawn out. It is a virus that attacks rapidly growing cells in the dog’s body – including the bone marrow, and the lining of the stomach and intestines -which causes bloody diarrhoea and vomiting. This results in a very sick, weak, anaemic animal with no immune system left to try and battle the virus. Because it is a virus, it does not respond very well to antibiotics, and for the most part all vets can do is provide supportive care until the patient starts to respond themselves.

The vaccination is very good – once you have a fully vaccinated dog the vaccination can be given every 3 years, but it does take several treatments to be fully effective in young puppies. (See our Puppy and Kitten Vaccination Schedule Page for more info). The disease is usually found in areas where there is a low level of vaccination in the community. Fortunately on the Tweed Coast we have a reasonable rate of vaccination, but we still see parvo frequently enough that we strongly recommend vaccination in all puppies and adult dogs.

Adenovirus (hepatitis) is an inflammation of the liver, which can be fatal We frequently see hepatitis in dogs, but the number of these cases that is caused by adenovirus is unknown. It is a disease that can cause sudden death in young animals, and cause permanent scarring and damage to the liver in older animals, who will then go on to shed the disease in their urine and faeces. Infected animals are often feverish, “sick” painful and vomit.

Distemper virus is extremely rare in our region. It used to be very common – a disease that caused a neurological symptoms such as twitching, paralysis, and seizures, along with eye and nasal discharges. It often was fatal. Fortunately, routine vaccinations have made this disease extremely rare, although it has not quite been eradicated yet.

NON-CORE VACCINATIONS

Bordatella Bronchiseptica and Parainfluenza virus

Although Kennel Cough (caused by bordatella bronchiseptica and parainfluenza) is not a part of the core vaccination, it is the minimum requirement to place your dog in a kennel. The KC vaccination is like the flu vaccination in people – it needs to be given every year to provide protection

In the Tweed Coastal region in particular, we see a lot of kennel cough, even in dogs that don’t leave their yards. As kennel cough is airborne, and can be spread much like the common cold in humans, we assume this is from dogs in close proximity to your fence, or yard, or drinking from your water bowl out the front (if you have one). Kennel cough is rarely fatal. Usually it is merely annoying, keeping both the owner and the pet up all night for weeks on end. It causes a deep, hacking cough, that sometimes results in vomiting a small amount of clear fluid.  It doesn’t respond well to treatment and sometimes can take several weeks to resolve.

Yearly Health Checks

Jasper, our clinic cat.

Your pet’s yearly health checks are an essential part of caring for your pet’s well being because our pets age so much more quickly than we do. On average there are about 7 dog years to every human year (although that can change depending on a dog’s size).

Each year we recommend coming in for a check up to ensure that your pet is in peak physical condition.

These yearly check ups usually involve:

  • A discussion about vaccinations and preventative health
  • Heart & lung checks
  • Dental checks
  • Eye examinations
  • Ear examinations
  • Coat and skin checks
  • Joint examinations
  • Routine blood and urine tests if indicated

As your pet gets older, we start to recommend yearly urine and blood tests.

Call us to book a yearly check up today. 02 6676 3199