Frequently Asked Questions (FAQ)

Dental Care & Oral Surgery

Periodontal disease is the most commonly diagnosed condition in adult dogs and cats. By age three, the majority of pets already have some degree of it. These questions cover what a professional dental cleaning involves, why anesthesia and dental X-rays are part of it, and how to care for your pet’s mouth at home.

Because a real dental cleaning is a medical procedure, not a cosmetic one. The disease that matters happens below the gumline, where plaque bacteria destroy the attachment between tooth and bone. Cleaning that area requires probing every tooth surface, scaling under the gumline, taking X-rays, and — often — extracting diseased teeth. None of that is possible in an awake animal.

General anesthesia also protects your pet’s airway. A cuffed endotracheal tube keeps water, bacteria, and tooth debris out of the lungs, and it allows us to deliver oxygen throughout the procedure. Awake scaling risks aspiration, fractured teeth, jaw injury, and a great deal of fear for an animal who does not understand what is happening.

Modern veterinary anesthesia is individualized: pre-anesthetic exam and bloodwork, an IV catheter and fluids, drug protocols chosen for that patient, and continuous monitoring of heart rate and rhythm, blood pressure, oxygen saturation, carbon dioxide, and temperature by a dedicated technician.

I’ve seen it offered at groomers and pet stores. We don’t offer it, and neither the American Veterinary Dental College nor the American Animal Hospital Association supports it. Scraping visible tartar off the crown makes the tooth look white while leaving the diseased pocket underneath untouched — the part that causes pain, bone loss, and tooth loss. It also removes the visual evidence that would have prompted an owner to seek real treatment.

Hand scaling an awake patient leaves microscopic scratches on the enamel that plaque adheres to more readily, and it cannot be done thoroughly on the inner (tongue-side) surfaces of the teeth. The result is a cleaner-looking mouth with the same or worse underlying disease.

A complete oral health assessment and treatment — often abbreviated COHAT — generally follows these steps:

  • Pre-anesthetic physical exam and bloodwork;
  • IV catheter placement, intravenous fluids, and pre-medication including pain control
  • Induction and intubation with a cuffed endotracheal tube; continuous multi-parameter monitoring and active warming
  • Full-mouth dental radiographs
  • Charting of every tooth: probing depths, gum recession, mobility, furcation exposure, fractures, resorptive lesions, masses
  • Ultrasonic and hand scaling above and below the gumline, followed by polishing and a final rinse
  • Treatment of any problems found — extractions, gingival flaps and suturing.
  • Recovery with a close monitoring until the pet is awake, warm, and comfortable
  • A discharge appointment with home care instructions

Because the treatment plan depends on what the radiographs and probing reveal, we call you during the procedure if anything beyond the estimated plan is needed.

Roughly two-thirds of each tooth sits below the gumline, and that is where most dental disease lives. Studies of dogs and cats with teeth that looked normal on visual exam found clinically important findings on radiographs in a large share of patients — and in mouths that already looked abnormal, X-rays changed the treatment plan in most cases.

Radiographs are the only way to identify tooth root abscesses, retained roots, unerupted teeth, dentigerous cysts, bone loss from periodontal disease, jaw fractures, tooth resorption in cats, and bone tumors. Extracting a tooth without a radiograph also risks leaving a fragment of root behind, which can become a source of chronic pain and infection.

Animals almost never stop eating because of dental pain. Survival instinct is stronger than discomfort, and the change happens so gradually that owners rarely notice. Pets with severely diseased mouths routinely eat normally the day before a procedure — and then act like they are years younger a week afterward.

The signs we look for instead: bad breath, tartar and red gum margins, bleeding when chewing, dropping food or chewing on one side, pawing at the face, decreased grooming in cats, a preference for softer food, or simply being less playful.

Veterinary dentistry uses a four-stage scale based on how much of the tooth’s bony attachment has been lost:

  • Stage 1 — gingivitis only. The gums are inflamed but no attachment is lost. This stage is fully reversible with cleaning and home care.
  • Stage 2 — early periodontitis, under 25% attachment loss.
  • Stage 3 — moderate periodontitis, 25–50% attachment loss.
  • Stage 4 — advanced periodontitis, more than 50% attachment loss. These teeth usually cannot be saved.

The stage is assigned per tooth, not per mouth, which is why one pet’s plan may include cleaning for most teeth and extraction of a few.

Sometimes it can. Root canal therapy, vital pulp therapy, and crown restoration are all available in veterinary medicine, and we are glad to refer to a board-certified veterinary dentist for teeth worth saving — particularly fractured canine and carnassial teeth in young or working dogs.

Extraction is recommended when the tooth’s support structure is gone or the tooth is a source of ongoing pain or infection: advanced periodontal disease with severe bone loss, a fractured tooth with pulp exposure that isn’t being treated endodontically, a tooth root abscess, tooth resorption, severe mobility, or retained deciduous (baby) teeth crowding adult teeth.

A painful, infected tooth is not neutral. Left in place it continues to seed bacteria into the bloodstream and destroy the surrounding jawbone.

Yes — and usually better than before. Dogs and cats do not chew their food the way people do; they tear and swallow. Pets who have had full-mouth extractions eat dry kibble, play with toys, and are noticeably more comfortable. Many owners describe a personality change in the weeks afterward and realize in retrospect how much pain the pet had been hiding.

We recommend softened food for the first one to two weeks while the extraction sites heal, then a return to the normal diet.

Extraction sites are closed with absorbable sutures that dissolve on their own over two to four weeks. Plan on soft food and no hard chews, bones, or tug toys for about two weeks. Mild blood-tinged saliva on the first day is normal.

Your pet goes home with pain medication — typically an anti-inflammatory, sometimes with an additional analgesic — and we may dispense antibiotics depending on what was found. Most pets are back to normal appetite within 24 to 48 hours.

Call us if you see persistent bleeding, swelling of the face, refusal to eat beyond the first day, or sutures that have come away early.

Age is not a disease. What matters is organ function, cardiac status, and how well the patient is prepared and monitored — and dental infection is itself a burden on an older animal’s kidneys, liver, and heart. Leaving a mouth full of infected teeth untreated is rarely the safer choice.

For older patients we typically expand the workup: full bloodwork and urinalysis, blood pressure, chest radiographs, and cardiac evaluation if a murmur or arrhythmia is present. The anesthetic protocol is then tailored around those findings, with IV fluid support, active warming, and continuous monitoring throughout.

It screens for problems that change the anesthetic plan: anemia, low platelets, kidney or liver dysfunction that affects drug metabolism, electrolyte abnormalities, high blood sugar, and signs of infection or inflammation. In cats we also check thyroid levels, since hyperthyroidism has significant anesthetic implications.

Occasionally the results lead us to postpone the procedure and investigate first. That is the point of running it.

It varies more than most owners expect. Small-breed dogs, brachycephalic breeds with crowded teeth, and many cats may need professional cleaning every 6 to 12 months. Large-breed dogs with good home care may go two to three years between procedures. We give you a recommendation based on your individual pet’s mouth at each exam.

Daily toothbrushing is by a wide margin the most effective home care there is. Use a pet toothbrush or finger brush with enzymatic pet toothpaste — never human toothpaste, which contains fluoride and sometimes xylitol. Brushing every other day or less has substantially less benefit; plaque mineralizes into tartar in about 48 to 72 hours.

Beyond brushing, look for the Veterinary Oral Health Council (VOHC) seal on dental diets, chews, water additives, and gels. Products carrying it have submitted data showing they actually reduce plaque or tartar.

Avoid anything harder than you could dent with a thumbnail: antlers, bones, hooves, hard nylon chews, and ice cubes are common causes of fractured carnassial teeth.

In several important ways. Tooth resorption affects a large proportion of adult cats — the tooth structure is progressively destroyed and replaced, which is painful, and the only treatment is extraction (or crown amputation for specific radiographic types). It is frequently invisible without X-rays.

Cats also develop feline chronic gingivostomatitis, a severe immune-mediated inflammation of the mouth that causes profound pain, drooling, weight loss, and reluctance to groom. Full-mouth or caudal-mouth extraction resolves or greatly improves the majority of these cats — it sounds drastic, and it is usually the kindest and most effective treatment available.

Cats hide oral pain especially well. Drooling, a scruffy coat from stopped grooming, turning the head to chew, or growling at the food bowl can all be dental in origin.

Because the mouth cannot be fully evaluated until the pet is anesthetized and radiographs are taken. A pet who appears to need a routine cleaning may turn out to need several extractions, and a mouth that looks bad may respond to cleaning alone. We provide a low and high estimate covering both scenarios, and we call you during the procedure before proceeding with anything beyond what was discussed.

After hours? If your pet has a surgical emergency when we are closed, go directly to your nearest 24-hour emergency veterinary hospital. During opening hours call us at (980) 981-4334.

Anesthesia & Surgery: What to Expect

These questions apply to every surgical procedure we perform, from a routine spay to an emergency abdominal surgery.

Safety comes from preparation and monitoring rather than from any one drug. Every surgical patient receives a physical exam, pre-anesthetic bloodwork, an IV catheter with fluid support, pain medication before the first incision, and a protocol tailored to their age, breed, and health status.

During the procedure a dedicated technician monitors heart rate and ECG, respiratory rate, end-tidal carbon dioxide, oxygen saturation, blood pressure, and body temperature, with active warming to prevent hypothermia. Recovery is monitored just as closely — the recovery period is when most anesthetic complications occur.

A full stomach increases the risk of regurgitation and aspiration under anesthesia, and it raises the chance of esophagitis afterward. We generally ask that food be withheld starting the night before, while water stays available until you leave for the hospital. We will give you exact timing when you schedule.

Puppies, kittens, very small dogs, and diabetic patients follow different instructions, because prolonged fasting risks low blood sugar. Please tell us if your pet is diabetic or on any medication so we can advise on the morning dose.

Multimodally — several classes of drug acting at different points in the pain pathway, started before surgery rather than after. Depending on the procedure that can include opioids, non-steroidal anti-inflammatories, local and regional nerve blocks, ketamine or lidocaine infusions, and gabapentin.

Pets go home with pain medication and clear instructions. Never give human pain relievers — ibuprofen, naproxen, and acetaminophen are toxic to dogs and cats, and acetaminophen can be fatal to cats in a single dose.

A normal incision is a clean line, pink to slightly red at the edges, with mild swelling and possibly a small amount of bruising in the first few days. Slight clear or blood-tinged fluid in the first 24 hours can be normal.

Call us for: increasing redness or swelling, heat, thick or foul-smelling discharge, an opening or gap in the incision, or any tissue visible through it. Also call if your pet is lethargic, painful, not eating, or has a fever.

Yes. A single determined licking session can open an incision, and a dehisced abdominal incision is a genuine emergency. The cone stays on at all times for the full healing period — usually 10 to 14 days — not just when you are out of the house. If the traditional cone is a poor fit, inflatable collars, soft cones, and surgical recovery suits are all reasonable alternatives; ask us which is appropriate for your pet’s incision.

For most soft tissue surgery, 10 to 14 days of leash-only walks for elimination, and no running, jumping, stairs, rough play, swimming, or baths. Internal healing lags well behind what the skin looks like — the incision can appear healed while the body wall is still at its weakest point.

If your pet feels too good too soon, that is normal and not permission to let them off leash. Ask us about safe mental enrichment for the recovery period.

After hours? If your pet has a surgical emergency when we are closed, go directly to your nearest 24-hour emergency veterinary hospital. During opening hours call us at (980) 981-4334.

Soft Tissue Surgery: Gastrointestinal Foreign Bodies

Dogs and cats swallow things they shouldn’t. Some pass uneventfully; others lodge in the stomach or intestine and become life-threatening within a day or two. These are the questions we are asked most often.

Call us instead of waiting. If the item was swallowed within roughly the last two hours and is not a sharp object or a caustic substance, we can often induce vomiting in the hospital and retrieve it before it ever reaches the intestine — the least invasive and least expensive option available.

Do not induce vomiting at home without speaking to us first. Hydrogen peroxide can cause serious stomach inflammation, and bringing a sharp object or a caustic chemical back up the esophagus does more damage than leaving it. There is no safe reliable way to make a cat vomit at home.

Tell us what was swallowed, how big it was, and when. String, thread, fabric, corn cobs, rocks, hair ties, socks, bones, coins, and toy fragments are the usual culprits.

  • Repeated vomiting, especially vomiting right after eating or drinking
  • Loss of appetite and lethargy
  • A painful, tense abdomen, or a “praying” stretch posture
  • Straining to defecate, or producing only small amounts of liquid stool or nothing at all
  • Drooling and nausea
  • Dehydration and collapse in later stages

Partial obstructions are sneakier — intermittent vomiting over several days or weeks, weight loss, and a pet who seems mildly off. Cats with linear foreign bodies may show remarkably subtle signs until they are critically ill.

We start with a physical exam and abdominal radiographs. Metal, stone, and bone show up clearly; fabric, plastic, and rubber often do not, so we look for indirect evidence — gas and fluid distension of the intestine, an abnormal bunched or plicated pattern, or a change in the gas pattern between two sets of images taken hours apart.

Abdominal ultrasound is more sensitive for non-radiopaque objects and shows intestinal wall health and free fluid. A contrast study is sometimes used. Bloodwork tells us about hydration, electrolytes, and whether other causes of vomiting — pancreatitis, kidney disease, Addison’s disease — should be considered.

Time is the mechanism of harm. An obstructing object presses on the intestinal wall and cuts off its blood supply. Within roughly 24 to 48 hours the wall can become devitalized and perforate, spilling intestinal contents into the abdomen — septic peritonitis, which is far more dangerous and far more expensive to treat than the original obstruction. Prolonged vomiting also causes dehydration and electrolyte derangements that themselves become life-threatening.

Some small, smooth objects genuinely do pass. Deciding which ones can be safely monitored — and monitoring them properly, with serial exams and imaging — is a medical judgment we make case by case.

A linear foreign body anchors at one end — under a cat’s tongue or at the pylorus — while the intestine continues trying to move the rest along. The bowel bunches up like fabric on a drawstring, and the string saws into the inner curve of the intestine. This can perforate the bowel in multiple places at once.

This is why we ask you to check under a cat’s tongue if you suspect string ingestion, and why you should never pull on a string you can see coming out of either end of your pet. Cut off access and bring them in.

Under general anesthesia we open the abdomen and inspect the entire gastrointestinal tract from stomach to colon, along with the other abdominal organs. What happens next depends on where the object is:

  • Gastrotomy — an incision into the stomach to remove an object that has not moved on
  • Enterotomy — an incision into the intestine, made just downstream of the object where the wall is healthier, then closed with fine absorbable suture
  • Resection and anastomosis — removal of a segment of intestine that is no longer viable, with the healthy ends sewn back together
  • Multiple enterotomies, sometimes needed for a linear foreign body
  • Abdominal lavage and, if there is contamination, drainage and prolonged antibiotic therapy

We often take a biopsy at the same time if the intestine looks abnormal, and in cats we may check the pancreas and liver while we are there.

The most serious is dehiscence — a breakdown of the intestinal suture line, usually between three and five days after surgery, releasing intestinal contents into the abdomen. It is uncommon but is the reason we monitor closely in that window and ask you to report any vomiting, fever, or lethargy immediately.

Risk is higher in patients who arrived septic, who had low blood protein levels, who had a section of bowel resected, or who had a linear foreign body. Straightforward cases caught early have a very good prognosis — the great majority go home eating within a day or two.

Most patients stay in hospital at least overnight, and longer if the intestine was compromised, on IV fluids, injectable pain control, and anti-nausea medication. We start small amounts of water and then a bland, easily digestible diet within about 12 to 24 hours — early feeding actually supports healing of the intestinal wall.

At home: 10 to 14 days of strict rest and cone use, small frequent meals of the prescribed diet before a gradual return to normal food, and incision monitoring. Recheck as scheduled.

Repeat offenders are common, and dogs who eat one sock generally eat another. Practical measures: hampers and trash behind closed doors, no rawhides or small toys unsupervised, sewing supplies and hair es put away, corn cobs and bones off the counter, and a basket muzzle for dogs who scavenge on walks. For persistent indiscriminate eating, ask us about behavioral causes and training approaches.

After hours? If your pet has a surgical emergency when we are closed, go directly to your nearest 24-hour emergency veterinary hospital. During opening hours call us at (980) 981-4334.

Soft Tissue Surgery: Bladder Stones & Cystotomy

Mineral concretions that form in the urinary bladder when urine chemistry, pH, concentration, and sometimes infection combine to let crystals aggregate. They range from sand-like grit to stones larger than a marble, and a pet can have one or hundreds.

The common types behave quite differently. Struvite stones in dogs usually form secondary to urinary tract infection with urease-producing bacteria and can often be dissolved with diet and antibiotics. Calcium oxalate stones cannot be dissolved and must be removed. Urate stones are associated with certain breeds and with liver shunts; cystine stones with a hereditary kidney transport defect. This is why stone type matters so much.

  • Straining to urinate, often mistaken for constipation
  • Frequent attempts producing small amounts of urine
  • Blood in the urine
  • Urinating in unusual places, or house-soiling in a previously trained pet
  • Licking at the genital area
  • Vocalizing or discomfort while urinating

Some stones cause no signs at all and are found incidentally on X-rays taken for another reason.

Because the male urethra is long and narrow and can be completely obstructed by a stone or by a plug of crystals and mucus. When urine cannot leave the body, potassium and toxins build up in the bloodstream within hours. Untreated, urethral obstruction causes heart rhythm abnormalities, kidney injury, bladder rupture, and death — often within 24 to 48 hours.

If a male dog or cat is straining repeatedly and producing little or no urine, treat it as an emergency and come in immediately. Do not wait until morning.

Sometimes. Struvite stones in dogs frequently dissolve over several weeks to a few months with a therapeutic dissolution diet plus antibiotics for the underlying infection. Urate and cystine stones can also respond to medical management in selected patients.

Calcium oxalate — the most common stone in cats and increasingly common in dogs — will not dissolve at all. Neither will silica or compound stones. And regardless of type, medical dissolution is off the table if the pet is obstructed, if a stone is lodged in the urethra, or if the stone is large enough to threaten obstruction.

We can often predict stone type from urine pH, crystal appearance, radiographic characteristics, breed, and culture results — but the definitive answer comes from analyzing the stone itself after removal.

Surgical opening of the bladder to remove stones. Through a small abdominal incision the bladder is isolated and opened, the stones are removed and counted, the bladder is flushed and the urethra retro-flushed to confirm nothing remains, and the bladder is closed with fine absorbable suture. We typically take a piece of bladder wall or a stone for culture, since infection is often present within the stone itself.

Post-operative radiographs are standard before your pet goes home. Small stones hide easily in bladder folds and in the urethra, and confirming a stone-free bladder is part of doing the procedure properly.

In male dogs with a stone lodged in the urethra that cannot be flushed back, a urethrotomy — or, for repeat offenders, a scrotal urethrostomy creating a permanent wider opening — may be needed.

Because prevention depends entirely on composition. A struvite former needs infection control and pH management; a calcium oxalate former needs a completely different diet, increased water intake, and monitoring of urine calcium; a urate former may need liver evaluation and a purine-restricted diet. Guessing wrong means the stones come back.

Recurrence rates are meaningful — calcium oxalate stones recur in a substantial proportion of dogs within a few years — so the analysis is what turns one surgery into a long-term plan.

Most pets go home the day of surgery or the following morning. Expect blood-tinged urine and increased frequency for several days; this reflects bladder wall inflammation and improves steadily. Pain medication is dispensed, and antibiotics if culture results warrant them.

The usual 10 to 14 days of restricted activity and cone use applies. Call us if your pet strains without producing urine, if bloody urine worsens rather than improves after the first few days, or if appetite and energy drop.

The plan follows the stone analysis, but the elements are usually: a prescription therapeutic diet, deliberately increased water intake (canned food, water fountains, multiple bowls), avoiding treats and supplements that undermine the diet, and monitoring — recheck urinalysis and, when indicated, imaging at intervals we’ll set with you.

The goal of monitoring is to catch a recurrence while stones are small enough to manage medically rather than surgically.

After hours? If your pet has a surgical emergency when we are closed, go directly to your nearest 24-hour emergency veterinary hospital. During opening hours call us at (980) 981-4334.

Soft Tissue Surgery: Pyometra

Pyometra is a bacterial infection of the uterus that fills it with pus. It is one of the true surgical emergencies of general practice, and it occurs almost exclusively in intact (unspayed) females.

Repeated heat cycles expose the uterine lining to progesterone, which thickens the lining, promotes glandular secretion, and suppresses the uterus’s ability to contract and its local immune defenses. Overtime this creates an environment where bacteria — usually E. coli ascending from the vagina — establish an infection the body cannot clear.

It typically appears within one to two months after a heat cycle, most often in middle-aged and older intact females, though it can happen at any age after the first cycle. Dogs given estrogen or progesterone-containing medications are at increased risk. Cats can develop pyometra too, though less commonly, because they ovulate only when bred.

  • Thick, foul-smelling, bloody or purulent vaginal discharge (open pyometra)
  • Lethargy, weakness, poor appetite
  • Marked increase in thirst and urination
  • Vomiting
  • A distended, sometimes painful abdomen
  • Fever, or a subnormal temperature in a patient going into shock

Any intact female who becomes unwell in the weeks following a heat cycle should be evaluated for pyometra the same day.

In an open pyometra the cervix is open and infected material drains out — unpleasant, but it relieves pressure and makes the diagnosis obvious. In a closed pyometra the cervix is shut. Pus accumulates under pressure inside the uterus with nowhere to go, the patient becomes sick much faster, and there is no discharge to alert the owner.

Closed pyometra carries a higher risk of uterine rupture and septic peritonitis, and it is the form most likely to be missed until the patient is critically ill.

History and physical exam raise the suspicion; imaging confirms it. Abdominal ultrasound shows a fluid-filled uterus and helps distinguish pyometra from pregnancy or other causes of uterine enlargement. Radiographs may show an enlarged uterus. Bloodwork typically shows a high white cell count with a left shift, dehydration, and sometimes kidney value elevation from the effect of bacterial toxins on the kidneys.

Ovariohysterectomy — surgical removal of the infected uterus and the ovaries — removes the source of infection and is curative. It is the treatment of choice in essentially every case. Delay allows bacterial toxins to be absorbed into the bloodstream, producing sepsis, organ injury, and the risk of the uterus rupturing into the abdomen.

The surgery itself is more demanding than a routine spay: the uterus is large, friable, and full of infected material, the blood vessels are enlarged, and the patient is often unstable going into anesthesia. We stabilize with IV fluids, antibiotics, and pain control first, but stabilization is measured in hours, not days.

Prognosis is good with prompt surgery — the overwhelming majority of dogs recover fully. It drops considerably once the patient is septic or the uterus has ruptured.

Medical management with prostaglandins, sometimes combined with a progesterone receptor blocker, exists and is reserved for young, valuable breeding females with open pyometra who are systemically stable. It is not a gentler alternative — it requires hospitalization, causes significant side effects, works more slowly, fails in a meaningful percentage of cases, and carries a high recurrence rate with subsequent cycles.

For a pet who is not intended for breeding, surgery is both safer and definitive.

Most patients stay in hospital for one to several days on IV fluids and antibiotics, depending on how sick they were at presentation. Once home: continued antibiotics and pain medication, cone use, restricted activity for 14 days, and recheck appointments. Kidney values that were elevated are rechecked to confirm they normalize.

Since the ovaries are removed along with the uterus, the patient is spayed by the procedure and will not have further heat cycles.

By spaying. Removing the ovaries and uterus eliminates the risk entirely. A significant proportion of intact female dogs develop pyometra by ten years of age, and an elective spay performed on a healthy young animal is a far smaller procedure — and a far smaller risk — than an emergency spay on a septic patient.

A rare exception is stump pyometra, an infection of a small remnant of uterine tissue with residual ovarian tissue after an incomplete spay. It is uncommon and treated by surgical removal of the remnant.

After hours? If your pet has a surgical emergency when we are closed, go directly to your nearest 24-hour emergency veterinary hospital. During opening hours call us at (980) 981-4334.

Soft Tissue Surgery: Urethral Prolapse in Male Dogs

Urethral prolapse is the protrusion of the lining of the urethra out through the tip of the penis. It is uncommon overall but is seen with some regularity in young intact male brachycephalic dogs — English Bulldogs above all.

A small, round, bright red to purple mass — often described as a pea, a cherry, or a doughnut — protruding from the tip of the penis. The most common presenting complaint is intermittent bleeding from the prepuce, sometimes noticed as spots of blood on bedding or the floor, along with excessive licking at the area.

It may come and go, appearing during excitement or straining and reducing on its own. Bleeding can be surprisingly heavy for the size of the tissue involved.

Predominantly young intact males, with English Bulldogs strongly over-represented and other brachycephalic breeds — French Bulldogs, Boston Terriers, Boxers, Pugs — also affected. There is likely an underlying anatomic or congenital predisposition in these breeds.

The mechanism is repeated increases in abdominal and urethral pressure. Anything that makes a dog strain or generate high pressure can precipitate it:

  • Chronic increased respiratory effort from brachycephalic obstructive airway syndrome — these dogs are essentially straining to breathe all day
  • Sexual excitement, mounting behavior, and masturbation in intact males
  • Straining to urinate, from urinary tract infection, urethritis, or bladder or urethral stones
  • Straining to defecate
  • Prostatic disease
  • Chronic coughing or vomiting

The link with the brachycephalic airway is the reason we evaluate the airway in any bulldog presenting with urethral prolapse, and one of the reasons airway surgery is often recommended alongside treatment of the prolapse.

The prolapsed tissue is exposed, easily traumatized, and becomes progressively inflamed and ulcerated, which is uncomfortable and drives more licking, which causes more trauma. Blood loss is usually minor but can become significant with chronic bleeding. If the tissue becomes strangulated it can become necrotic.

It does not usually obstruct urine flow on its own, but a dog who is straining because of stones or infection may have both problems at once — so a dog with urethral prolapse who cannot urinate needs to be seen immediately.

Diagnosis is visual, but the important work is finding the underlying cause. That typically includes urinalysis and urine culture, imaging of the bladder and urethra to look for stones, a rectal exam and prostatic evaluation, and an assessment of the airway in brachycephalic patients. Treating the prolapse without addressing what caused the straining leads to recurrence.

Treatment is chosen based on how severe, how chronic, and how damaged the tissue is:

  • Conservative management — for a small, first-time, minimally traumatized prolapse: treat the underlying cause, neuter, restrict excitement, and use anti-inflammatory and sedative support. Recurrence is common if the trigger persists.
  • Manual reduction with a temporary purse-string suture — the tissue is replaced with a urinary catheter in place and a suture holds it while inflammation resolves. Simple, but a high proportion recur.
  • Urethropexy — the urethra is tacked to the inside of the penis through small incisions, holding the tissue in place without removing it.
  • Resection and anastomosis — the prolapsed segment is amputated and the urethral mucosa is sutured to the penile surface. This is the most definitive option and the one with the lowest recurrence rate; it is the usual choice for a severe, necrotic, or recurrent prolapse. Expect some bleeding from the site for several days afterward, particularly with excitement.

We strongly recommend it. Neutering removes the sexual excitement and mounting behavior that drive a large share of these cases, and it substantially reduces recurrence. It also removes prostatic disease as a future contributor. In an English Bulldog it can often be combined with airway surgery under a single anesthetic — with the caveat that brachycephalic patients need specific anesthetic precautions.

Plan on a cone at all times for at least two weeks — licking is the single biggest cause of complications here. Expect intermittent bleeding from the surgical site for up to a week or two, more noticeably when the dog is excited; this is expected and usually self-limiting.

Keep the dog calm and away from females in heat, use a harness rather than a neck collar, and give sedative medication if we have prescribed it. We will recheck the site and confirm the dog is urinating normally.

Call us for a stream that has become thin or interrupted, inability to urinate, heavy or continuous bleeding, or recurrence of visible prolapsed tissue.

After hours? If your pet has a surgical emergency when we are closed, go directly to your nearest 24-hour emergency veterinary hospital. During opening hours call us at (980) 981-4334.

Brachycephalic Airway Surgery: Stenotic Nares & Soft Palate Resection

Brachycephalic obstructive airway syndrome (BOAS) affects short-faced breeds — French and English Bulldogs, Pugs, Boston Terriers, Boxers, Shih Tzus, Pekingese, and, among cats, Persians and Himalayans. These dogs have the soft tissue of a longer-nosed ancestor packed into a shortened skull, and the excess tissue obstructs airflow.

A collection of anatomic abnormalities that together make breathing harder than it should be. Most affected dogs have more than one:

  • Stenotic nares — nostrils that are narrowed or slit-like, restricting airflow at the very first point of entry
  • Elongated soft palate — the soft palate extends past the tip of the epiglottis and flaps into the airway with each breath, the usual source of the snoring sound
  • Everted laryngeal saccules — small pouches of tissue pulled into the larynx by chronic negative pressure, further narrowing the opening
  • Hypoplastic trachea — an abnormally narrow windpipe
  • Aberrant nasopharyngeal turbinates — excess nasal tissue obstructing the back of the nasal passage
  • Laryngeal collapse — a late, progressive consequence in which the cartilage of the larynx loses rigidity and falls inward

The first two are the primary problems, and they are the ones we address surgically in general practice. The others are largely secondary — caused by years of increased breathing effort — which is why timing matters.

It is common in the breed, but common is not the same as normal or harmless. Noise means turbulent airflow, and turbulent airflow means the dog is working to breathe. That work is what causes the airway to deteriorate overtime.

Owners frequently tell us after surgery that they hadn’t realized how much their dog had been struggling until they saw them afterward — sleeping quietly, playing longer, tolerating a walk in warm weather.

  • Loud snoring, snorting, or a raspy sound while awake
  • Exercise intolerance — needing to stop and rest on walks
  • Poor heat tolerance; panting that doesn’t settle
  • Gagging, retching, regurgitation, vomiting, or frequent swallowing
  • Sleeping with the head propped up, or with a toy in the mouth to keep the airway open
  • Blue or grey gums, collapse, or fainting — an emergency
  • Restless, noisy sleep and daytime tiredness

The gastrointestinal signs surprise many owners. The extreme negative pressure these dogs generate pulls stomach contents up the esophagus, and a majority of BOAS patients have some degree of reflux, esophagitis, or hiatal hernia. These signs often improve after airway surgery.

Earlier is better. The primary abnormalities are present from birth; the secondary ones — everted saccules, laryngeal collapse — develop from years of increased effort and are far harder to fix. Correcting nares and palate before that damage accumulates gives the best long-term result.

For dogs with clear signs, we often recommend surgery at the time of spay or neuter, around 6 to 12 months of age, so it can be done under one anesthetic. Stenotic nares alone can be corrected even earlier if the dog is significantly affected.

That said, older dogs benefit too. We simply set expectations based on what the airway exam shows at the time.

A conscious exam tells us about the nostrils, the noise, and the effort. The palate, larynx, and saccules can only be assessed under light anesthesia, so the definitive airway exam is performed at the start of the procedure — we look at the palate relative to the epiglottis, check for everted saccules, and grade laryngeal function and collapse. Chest radiographs let us evaluate the tracheal diameter, the heart, and the lungs.

We discuss with you in advance what we may find and what we would recommend doing about each finding.

A wedge of tissue is removed from the side of each nostril and the edges are sutured, permanently widening the opening. Variations include vertical, horizontal, and lateral wedge techniques, and an alar fold resection or ala-vestibuloplasty for dogs whose obstruction extends deeper into the nasal vestibule.

It is quick, well tolerated, and often produces a dramatic improvement on its own — the nostrils are the narrowest point in many of these dogs. There is a small amount of bleeding at the time and mild swelling for a few days. Cosmetically the nose looks slightly more open; most owners consider it an improvement.

Also called staphylectomy. The excess length of the soft palate is trimmed back so that it just touches the tip of the epiglottis rather than overhanging into the airway, and the cut edge is closed or sealed. It can be performed with scissors and sutures, a CO2 laser, or a bipolar sealing device — all are effective, and the sealing techniques tend to produce less bleeding and swelling.

Some patients also benefit from a folded flap palatoplasty, which reduces the thickness of the palate as well as the length. If everted laryngeal saccules are present and obstructive, they are removed at the same time.

The main one is swelling of the airway during recovery, at exactly the moment the breathing tube comes out. This is why brachycephalic patients are recovered with particular care: pre-oxygenation before induction, rapid intubation, anti-inflammatory medication, keeping the tube in as long as the patient tolerates it, and close observation afterward. Occasionally a patient needs to be re-intubated, and very rarely a temporary tracheostomy.

Other risks include bleeding, regurgitation and aspiration pneumonia, and — if the palate is trimmed too short — nasal reflux of food or water, which is why the resection is measured against the epiglottis rather than estimated.

Overall, planned surgery in a young dog carries meaningfully lower risk than emergency airway management in an older dog in a crisis. Complication rates rise with age, with obesity, and with the presence of laryngeal collapse.

Most patients are monitored in hospital through the day of surgery and often overnight, because the first 12 to 24 hours are the critical window for airway swelling. Expect some noisy breathing, coughing, and a slightly gaggy swallow for a few days — the tissues are inflamed.

At home, for roughly two weeks: soft or blended food and water offered in small amounts, a harness instead of a neck collar (permanently, ideally), strict rest with no running or excitement, cool and calm surroundings, and medication as dispensed. No cone is usually needed for the palate, though it may be for the nostrils.

Call us right away if you see

Call us for laboured breathing, blue or pale gums, coughing with fever or lethargy, or an inability to keep water down.

It improves it, often substantially, but it does not turn a brachycephalic dog into a long-nosed one. The published outcomes are good: the large majority of dogs breathe more easily, exercise better, tolerate heat better, and have fewer gastrointestinal signs after nares and palate surgery.

The strongest predictors of a good outcome are being young at the time of surgery and having no laryngeal collapse. Dogs with advanced laryngeal collapse improve less and may need referral to a surgical specialist for additional procedures.

Lifelong management still matters: keeping the dog lean, using a harness, avoiding heat and humidity, avoiding over-exertion, and managing any reflux. Weight is the single most modifiable factor — even a small amount of excess weight measurably worsens BOAS.

It requires more planning, and with that planning it is managed safely every day. These patients are prone to airway obstruction when sedated, to reflux, and to swelling at extubation. Our approach includes preoxygenation, a rapid and secure intubation, medication to reduce reflux where indicated, careful positioning, temperature control, delayed extubation, and continuous observation during recovery until the airway is stable.

Cardiac and airway pre-screening is worth doing in these breeds before any elective procedure, including a routine spay or neuter or a dental.

After hours? If your pet has a surgical emergency when we are closed, go directly to your nearest 24-hour emergency veterinary hospital. During opening hours call us at (980) 981-4334.

Spay & Neuter

Ovariohysterectomy — removal of both ovaries and the uterus through an incision in the abdomen. Some surgeons perform ovariectomy instead, removing only the ovaries; the outcomes for behavior, mammary tumor prevention, and pyometra prevention are equivalent, since it is the hormonal cycling from the ovaries that drives those conditions. Both are done under general anesthesia with full monitoring and multimodal pain control.

Castration — removal of both testicles through a small incision in front of the scrotum in dogs, or through the scrotum in cats. The scrotum itself is left in place; in dogs it flattens over the following weeks. It is a shorter procedure than a spay with a quicker recovery, but it is still abdominal-grade surgery in terms of the aftercare it deserves.

  • Females: eliminates the risk of pyometra and of ovarian and uterine disease; greatly reduces mammary tumor risk when performed early (roughly half of canine mammary tumors and the great majority of feline ones are malignant); no heat cycles, bleeding, or unwanted litters
  • Males: eliminates testicular cancer; prevents benign prostatic hyperplasia, prostatic cysts and infection, and perineal hernia; reduces roaming, urine marking, and some forms of inter-male aggression
  • Both: no unwanted litters, and in males a reduced tendency to escape and be hit by a car or injured in a fight

This has genuinely changed in recent years, and the honest answer is that it depends on species, breed, size, sex, and lifestyle.

  • Cats: around five to six months is standard, before the first heat. Early-age sterilization from about eight weeks is safe and is widely used in shelter medicine.
  • Small-breed dogs (under roughly 45 lb adult weight): around six months is generally appropriate, as orthopedic concerns are minimal in these breeds.
  • Large and giant-breed dogs: there is good evidence in several breeds that sterilizing before growth plates close raises the risk of cranial cruciate ligament rupture and hip dysplasia, and in some breeds of certain cancers. Many of these dogs are better served by waiting until 12 to 18 months, or by an alternative such as vasectomy or ovary-sparing spay where appropriate.
  • Female dogs specifically: mammary tumor protection is greatest when spayed before the first heat and decreases with each subsequent cycle, so there is a real trade-off to weigh against orthopedic considerations.

We would rather have this conversation about your individual dog than apply a single rule to every patient. Your household situation matters too — an intact female in a home where an unplanned litter is a real possibility is a different calculation.

Personality — the core temperament — does not change. What may change are hormone-driven behaviors: roaming, marking, mounting, and heat-related behavior. Fear-based or anxiety-based aggression is not reliably improved by neutering and can occasionally be worse; we’re happy to discuss behavior specifically if that is part of your reason for considering it.

Weight gain is real but manageable. Metabolic rate drops after sterilization, so a pet fed the same amount will gain. Reduce the portion by roughly a quarter after surgery, or switch to a diet formulated for sterilized pets, and monitor body condition. Sterilization does not make a pet fat; unchanged feeding does.

Food is withheld from the night before, with water available. At drop-off we perform a physical exam, confirm the plan, and run pre-anesthetic bloodwork. Your pet receives pre-medication with pain control, an IV catheter, fluids, and then induction and intubation with continuous monitoring throughout. Local blocks and, for spays, an intra-abdominal or incisional block, are commonly used in addition.

Most routine spays and neuters go home the same afternoon, awake and comfortable, with pain medication and written instructions.

  • Cone or recovery suit at all times for 10 to 14 days
  • Leash walks only for elimination — no running, jumping, stairs, or play
  • No baths, swimming, or ointments on the incision; keep it dry
  • Check the incision twice daily
  • Give pain medication as directed, and never give human medications
  • A small amount of grogginess and reduced appetite on the first evening is normal

Most incisions are closed with absorbable sutures under the skin and need no removal; if skin sutures or staples were placed we will schedule their removal. A small firm lump under a healing incision is usually normal suture reaction, but have us look at anything you are unsure about.

That is cryptorchidism, and it is a reason to neuter rather than a reason to wait. A retained testicle sits at body temperature instead of in the scrotum and has a markedly higher risk of becoming cancerous, as well as a risk of twisting on itself. It is also heritable, so affected dogs should not be bred.

The surgery is more involved than a routine neuter because the retained testicle must be located — in the inguinal region or inside the abdomen — so it takes longer and costs more, and recovery follows abdominal surgery precautions if the abdomen was entered.

Yes, in both cases, but with important caveats. During heat the reproductive tract is engorged with blood, which lengthens the surgery and increases bleeding risk. When it is elective, we prefer to wait until two to three months after the cycle ends. When it is not — a pregnancy the owner cannot continue, a pyometra risk, a scheduling reality — it is done, with the risks discussed beforehand.

Please tell us if there is any chance your pet is pregnant or has recently been in heat. It changes our planning, not our willingness.

Spay and neuter are among the most commonly performed surgeries in veterinary medicine and complications are uncommon. Those that occur include anesthetic reactions, bleeding, incisional infection or swelling (most often from licking or over-activity), suture reaction, and — in females, rarely — urinary incontinence later in life, which is usually well controlled with medication.

The great majority of complications we see are self-inflicted during the recovery period. The cone and the leash are doing more work than they get credit for.

After hours? If your pet has a surgical emergency when we are closed, go directly to your nearest 24-hour emergency veterinary hospital. During opening hours call us at (980) 981-4334.

Vomiting & Diarrhea

Gastrointestinal upset is one of the most common reasons pets are seen, and the causes range from a raided trash can to an intestinal obstruction to kidney disease. These questions cover how to tell the difference and what we do about it.

Emergency — act now

Come in right away — or go to an emergency hospital if we are closed — for any of the following:

  • Repeated unproductive retching or a distended, tight abdomen — this can be gastric dilatation-volvulus (bloat), which is fatal within hours
  • Vomiting that persists more than a few hours with no ability to keep water down
  • Blood in vomit, or vomit that looks like coffee grounds
  • Black, tarry stool, or large amounts of fresh blood in stool
  • Known or suspected ingestion of a foreign object, a toxin, or a medication
  • Weakness, collapse, pale gums, or a painful abdomen
  • Any vomiting or diarrhea in an unvaccinated puppy or kitten
  • A very young, very old, small, diabetic, or otherwise chronically ill pet — these patients dehydrate and destabilize quickly
  • Signs lasting more than 24 to 48 hours in an otherwise healthy adult

For a single episode in an otherwise bright, healthy adult with no red flags: withhold food for 6 to 12 hours (not longer, and not at all in puppies, kittens, or diabetics) while keeping small amounts of water available. Then offer a small bland meal — a prescription gastrointestinal diet if you have one, otherwise boiled skinless chicken or lean turkey with white rice — and feed small portions every few hours for two to three days before transitioning back to normal food over another two to three days.

Do not give over-the-counter human medications without asking us. Pepto-Bismol contains salicylate and is dangerous in cats; Imodium is unsafe in certain breeds and inappropriate when diarrhea is infectious; and NSAIDs made for people cause gastrointestinal ulceration and kidney injury in pets.

It matters a great deal, because they point to different parts of the body. Vomiting is an active process — retching, abdominal heaves, nausea beforehand — and the material comes from the stomach or upper intestine, often with bile. Regurgitation is passive: food comes back up with little effort, often undigested and tube-shaped, sometimes long after eating.

Regurgitation points to the esophagus — megaesophagus, esophagitis, a stricture, a vascular ring anomaly, or hiatal hernia, the last of which is common in brachycephalic dogs. It also carries a higher risk of aspiration pneumonia. A video of an episode on your phone is genuinely one of the most useful things you can bring to the appointment.

A long list, which is why the workup is individualized:

  • Dietary indiscretion — garbage, table scraps, an abrupt diet change
  • Intestinal parasites — roundworms, hookworms, whipworms, Giardia, coccidia
  • Infections — parvovirus, panleukopenia, Salmonella, Campylobacter, Clostridium
  • Foreign body obstruction
  • Pancreatitis
  • Toxins — chocolate, xylitol, grapes and raisins, lilies in cats, human medications, cleaning products, certain plants
  • Systemic disease — kidney disease, liver disease, Addison’s disease, diabetic ketoacidosis, hyperthyroidism in cats
  • Chronic enteropathy and inflammatory bowel disease
  • Food allergy or intolerance
  • Cancer, including intestinal lymphoma
  • Motion sickness, anxiety, or medication side effects

Sometimes we can, and for a straightforward case of dietary indiscretion in a healthy pet that is a reasonable approach — symptomatic treatment with anti-nausea medication, fluids, and a bland diet. The reason we don’t do it reflexively is that anti-nausea medication is very effective at masking the signs of an obstruction. A dog with a sock in the intestine can look considerably better for a day on an anti-emetic while the intestinal wall continues to deteriorate. When the history, exam, or duration raises that possibility, we recommend imaging first.

  • A fecal test for parasites, and a Giardia antigen test
  • Bloodwork and electrolytes — organ function, hydration, inflammation, glucose
  • Urinalysis, which is needed to interpret kidney values properly
  • Abdominal radiographs, for obstruction, foreign material, or organ size
  • Abdominal ultrasound, for intestinal wall detail, pancreas, lymph nodes, and free fluid
  • Parvovirus or panleukopenia test in young patients
  • Pancreatic lipase testing for suspected pancreatitis
  • Thyroid testing in older cats, and cortisol testing where Addison’s disease is a consideration
  • For chronic cases: B12 and folate, diet trial, and sometimes endoscopy with biopsy

We recommend tests in the order that will most efficiently rule out the things that would change treatment today.

Small-intestinal diarrhea tends to produce large volumes, a normal or slightly increased frequency, sometimes weight loss and vomiting, and possibly melena — black, tarry stool from digested blood higher up.

Large-intestinal diarrhea produces small volumes with urgency and much greater frequency, often with mucus and streaks of fresh red blood (hematochezia), and straining. It is uncomfortable but frequently less concerning systemically than small-bowel disease.

A photo of the stool, unglamorous as it is, helps us more than a description. So does bringing a fresh sample to the appointment.

Veterinary-specific probiotics have reasonable evidence for shortening episodes of acute diarrhea and are safe. Human probiotics are formulated for different species of bacteria and are less useful.

Deworming is often appropriate as part of the workup, since parasites are common and fecal tests are not perfectly sensitive — a negative fecal does not entirely rule them out. We choose the dewormer based on what we are targeting; over-the-counter products often cover only roundworms.

Antibiotics, by contrast, are frequently not indicated. Most acute diarrhea is self-limiting, and unnecessary antibiotics disrupt the gut microbiome and can prolong recovery. We reserve them for specific indications.

Chronic signs — more than about three weeks — call for a systematic approach rather than repeated symptomatic treatment. Typically: rule out parasites and systemic disease with testing, then a strict diet trial using either a hydrolyzed protein or a true novel protein diet for six to eight weeks with absolutely nothing else by mouth, since a substantial share of chronic cases are diet-responsive.

If diet doesn’t resolve it, the next steps are B12 and folate levels, pancreatic function testing, ultrasound, and potentially endoscopic or surgical biopsy to distinguish inflammatory bowel disease from lymphoma and other causes. Many of these pets do very well once the right category is identified.

More worried than with an adult. Young animals have minimal reserves and can become dehydrated and hypoglycemic within hours. Parvovirus in puppies and panleukopenia in kittens are rapidly fatal without hospitalization, and both begin with lethargy, vomiting, and diarrhea that may become bloody.

Any vomiting or diarrhea in an incompletely vaccinated puppy or kitten should be seen the same day.

Transition foods gradually over five to seven days. Keep trash, compost, and counters inaccessible. Skip table scraps, fatty foods, and bones — a single high-fat meal can trigger pancreatitis. Stay current on parasite prevention, most of which covers intestinal worms monthly. Store medications where they cannot be reached, and know which foods and plants are toxic before a holiday rather than during one.

Allergies & Itchy Skin

Allergies in dogs and cats show up in the skin and ears far more often than in the nose. Itching, recurrent infections, and chronic ear disease are the usual presentation, and the goal of treatment is long-term control rather than a one-time cure.

  • Scratching, licking, chewing, and rubbing — especially feet, face, ears, armpits, groin, and around the tail base
  • Red skin, rashes, bumps, hair loss, and darkened or thickened skin over time
  • Saliva staining — rust-coloured feet and fur from constant licking
  • Recurrent ear infections, head shaking, and odor
  • Recurrent skin infections and hot spots
  • In cats: overgrooming with symmetrical hair loss, small crusty bumps (miliary dermatitis), or eosinophilic granuloma lesions on the lips, chin, or abdomen
  • Sometimes gastrointestinal signs alongside the skin signs, particularly with food allergy

Sneezing and watery eyes, the human picture of allergy, are relatively uncommon in pets.

Three, and a pet can have more than one at once — which is why partial responses to treatment are common:

  • Flea allergy dermatitis — a hypersensitivity to flea saliva. The most common allergy in dogs and cats, and classically causes itching over the rump, tail base, and back of the thighs.
  • Environmental allergy (atopic dermatitis) — reaction to pollens, grasses, molds, dust mites, and danders. Usually begins between one and three years of age, is often seasonal at first, and tends to become year-round.
  • Food allergy — an immune reaction to a protein in the diet, most often chicken, beef, dairy, egg, or fish rather than grain. It is non-seasonal, can begin at any age, and often involves the ears and sometimes the gut.

Contact allergy exists but is much less common than owners assume.

Because an allergic pet can react to a very small number of bites, and because pets groom fleas off themselves efficiently — by the time you see one, the population has been there a while. Flea dirt on a comb is often absent in the very animals who are most allergic.

Strict year-round flea prevention on every pet in the household is the first step in any itch workup. It is the cheapest, safest variable to eliminate, and until it is eliminated we cannot interpret the response to anything else. Indoor-only cats are not exempt; fleas come in on people, dogs, and other animals.

For environmental allergies, yes — serum allergy testing and intradermal skin testing exist. But they are not diagnostic tests. They do not tell us whether your pet has atopic dermatitis; they identify which allergens to include in immunotherapy for a pet already diagnosed with it. The diagnosis itself is made clinically, by ruling out fleas, infections, parasites, and food.

For food allergy, blood and saliva tests are not reliable. Studies have shown them returning positive results for foods the animal has never eaten and for samples that were not from a live animal at all. The only valid way to diagnose food allergy remains a strict elimination diet trial followed by a rechallenge.

Your pet eats a prescription hydrolyzed protein diet or a genuine novel protein diet — and nothing else at all — for eight to twelve weeks. Nothing else means no treats, no flavored medications or supplements, no flavored heartworm preventive, no dental chews, no table food, no licking the other pet’s bowl.

If the itching resolves, we confirm the diagnosis by reintroducing the original diet. If signs return, the diagnosis is made, and we can then work out which specific proteins are the problem.

Over-the-counter limited-ingredient diets are not adequate for a trial. Testing has repeatedly found proteins in them that are not on the label. This is also why grain-free diets rarely help: grain is an uncommon allergen, and it is the protein source that usually matters. Grain-free diets carry their own concerns and should be chosen for a reason, not by default.

  • Oclacitinib (Apoquel) — an oral medication that blocks itch signaling directly; works within hours, given daily
  • Lokivetmab (Cytopoint) — an injectable antibody targeting a key itch cytokine, given every four to eight weeks; useful in dogs where daily medication is difficult
  • Cyclosporine (Atopica) — an oral immune modulator; slower to take effect but effective for long-term control in both dogs and cats
  • Corticosteroids — fast and inexpensive, appropriate for short courses and flares, but with meaningful side effects over the long term
  • Topical therapy — medicated shampoos, mousses, sprays, and wipes to treat infection and remove allergens from the coat
  • Omega-3 fatty acid supplementation — modest benefit, best as an adjunct
  • Antihistamines — much less effective in pets than in people, but occasionally helpful as part of a combination
  • Allergen-specific immunotherapy — allergy shots or sublingual drops

Cats have a somewhat different toolkit; not every canine medication is licensed or appropriate in cats, and we will tailor accordingly.

They work, and we use them deliberately for flares. The concern is cumulative: long-term steroid use causes increased thirst, urination, and appetite, muscle loss, panting, weight gain, thinning skin, urinary tract infections, elevated liver values, and — with time — a higher risk of diabetes and predisposition to other infections.

Modern targeted therapies achieve comparable itch control with a much better long-term safety profile. When a pet needs continuous therapy for years, that difference matters.

Allergen-specific immunotherapy is a customized formulation of the allergens your pet reacts to, given as injections or under-the-tongue drops, gradually retraining the immune system to tolerate them. It is the only treatment that modifies the underlying disease rather than suppressing the symptom.

It is a long commitment — improvement typically takes six to twelve months, and it is usually continued for life — and it works well in a majority of patients, though not all. For a young dog facing a decade of year-round allergy, it is often the best long-term investment available, and it can reduce or eliminate the need for daily medication.

Usually one of three reasons. First, secondary infection: allergic skin is prone to bacterial (Staphylococcus) and yeast (Malassezia) overgrowth, and these cause a great deal of the itch. Treat the infection and the pet improves; the underlying allergy is still there, and the infection returns unless it is controlled.

Second, allergies change with the seasons and with the year — a dog controlled on one plan in winter may need more in spring, and atopic dermatitis tends to broaden over time.

Third, incomplete flea control, or a food component that crept back in.

This is why we recommend skin cytology at recheck visits rather than refilling medication blindly. Looking at the cells under the microscope tells us whether we are managing allergy, infection, or both — and whether the organism present is likely to be resistant.

Very often, yes. In dogs, chronic or recurrent otitis is one of the most common presentations of allergic skin disease, and in some dogs the ears are the only place it shows. Treating each infection without addressing the allergy leads to an endless cycle — and repeated cycles cause the ear canal to thicken and narrow permanently, eventually to the point where medication cannot reach the canal at all.

We examine and swab the ears, look at the sample under the microscope to identify bacteria versus yeast, and culture when infections are recurrent or resistant. Long-term control means treating the allergy, not just the ear.

  • Bathe with a veterinary-recommended shampoo — it physically removes allergens and treats surface infection; leave it on for the contact time on the label
  • Wipe the feet and belly after walks during pollen season
  • Wash bedding weekly in hot water; consider a HEPA filter for dust-mite-sensitive pets
  • Keep flea prevention absolutely current, year-round, on every pet in the house
  • Give omega-3 supplements as directed
  • Keep a simple diary of flare-ups — dates, severity, diet changes, environment — patterns emerge that are hard to see otherwise
  • Do not use human topical creams containing steroids or hydrocortisone without asking us; pets lick them off

When signs are severe or poorly controlled despite a well-executed plan, when infections are recurrent or resistant on culture, when intradermal allergy testing is needed to formulate immunotherapy, or when the picture is atypical and may reflect an immune-mediated disease rather than allergy. We are glad to refer, and to continue managing the day-to-day care alongside the specialist.