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What Do Heart Murmurs Sound Like?

This post was originally published on 12/22/2014, but has been updated to provide you with even more information. Welcome to another edition of Medicine Versus Mom where Carol Bryant from Fidose of Reality and I discuss veterinary medical issues experienced by pets and their families.

Today, I want to discuss heart murmurs. Heart murmurs can occur for a variety of reasons, in both dogs and cats, and can be a long term issue for your pet.

While working at the veterinary hospital I met quite a few pets who had heart murmurs. Some of which were so severe that you could even feel them once you knew what you were looking for. However, most heart murmurs are detected with a stethoscope. Today our goal is to provide you with clarity on heart murmurs and what you can do for your pet if they have been diagnosed with a heart murmur.

What is a Heart Mumur?

During my undergraduate degree, I was fortunate enough to take a physiology course. During that course, I learned that a heartbeat is actually the sound of two valves closing. When you hear a heartbeat, you may not actually distinguish that what you are hearing is not one sound, but two different sounds occurring within milliseconds of each other. The heartbeat is a lub-dub, not just a dub.

A murmur is an abnormal extra sound (which can sometimes drown out the normal sounds).  Murmurs most commonly occur between the “lub” and the “dub” and have a “shooshing” or “whooshing” quality. – Dr. Mark Rishniw, ACVIM

Understanding that a heartbeat is a series of sounds rather than one, will really help you understand what a heart murmur is, and what exactly you are hearing. The two separate sounds are the result of multiple valves closing as blood flows through the heart.

What Do Heart Murmurs Sound Like?

Photo Courtesy of http://philosophyofdog.com

The picture above provides a visual example of how blood flows through the heart.

Blood initially enters the heart in the right atrium.  The blood then passes through the tricuspid valve into the right ventricle which pumps the blood through the pulmonic valve into the lungs to pick up oxygen (among other things).  The oxygenated blood then enters the left atrium.  Blood in the left atrium passes through the mitral valve to reach the left ventricle, which then pumps the blood through the aortic valve out to the rest of the body.  (Veterinary Partner).

These valves exist to keep blood flowing forward, and prevent it from flowing backward. When the valve is not opening or closing properly, this disturbs the blood flow and creates turbulence, which causes a murmur (Veterinary Partner).

A heart murmur is an extra heart vibration that occurs when there is disturbance in the blood flow (PetMD).

It is imperative to understand that a murmur is not an arrhythmia. An arrhythmia is defined by irregularity and possibly erratic rate of the heartbeat (Merck). Basically, if the flow of the blood is not disrupted, but the rhythm (lub-dub) sounds irregular, than you are dealing with an arrhythmia, not a murmur.

What causes a heart murmur?

According to PetMD, murmurs are caused by the following:

  • Disturbed blood flow caused by high blood flow through a normal or abnormal valve.
  • Flow disturbances identified by forward flow through abnormal valves.
  • Flow disturbances identified by regurgitant blood flow due to an abnormal valve.

According to Veterinary Partner, the most common murmurs in dogs are associated with leaky mitral valves. Sometimes, murmurs are caused by holes between two of the chambers in the heart, or narrowing of a chamber or vessel, or anemic blood.

What are the different kinds of murmurs?

  • There are benign (non-harmful) murmurs in which the cause of the murmur is not associated with a known heart disease. These kinds of murmurs are not usually found in adult dogs, but can be found in puppies and cats of all ages. Characteristically, they have a soft sound and tend to be intermittent. Heart murmurs brought on by anemia or excitement often fall into this category (Veterinary Partner).
  • Congenital Murmurs are present from birth. The defect that is causing the murmur is always there, but may not be heard until later than life (Veterinary Partner).
  • Acquired Murmurs are brought on throughout the course of the pet’s life, but they are often associated with a heart or valve disease (Veterinary Partner).

Grading Scale

Murmurs are classified on a grading scale. Grade of a murmur is determined by sound (time and intensity), configuration, and location (PetMD).

HeartMurmurs

What do they sounds like?

A veterinarian that I worked for at Acorn Veterinary Clinic in Davis, California explained it to me the best. Dr. Jackman said that a heart murmur sounds like a washing machine as opposed to a lub-dub, this analogy would help me identify murmurs very well in the future.

The following videos are a series of audio clips, that show a view of the valves and how they are working with each type of murmur. Make sure to have your volume on, but I promise you this is very interesting. (I also want to thank Steven Farmer, DO for creating these videos).

First, this is the sound of a normal heart.

This second video is an Aortic Stenosis Murmur, which is defined but the AKC Canine Health Foundation as the narrowing of the aortic valve, or just above it. Listen for the “washing machine sound”.

This video is an Aortic Regurgitation Murmur, defined by Merck Manuals as back flow of blood from the aorta into the left ventricle.

This last video is a Mitral Regurgitation Murmur (the most common in dogs) , which can be defined by VCA Hospitals as back flow from the left ventricle to the left atrium.

If you were able to hear subtle differences between these videos, then you have a great ear for heart murmurs. These are very challenging to distinguish, but will give you an idea of what your veterinarian is listening for.

Symtoms

If your pet’s murmur is due to a structural heart diseases, they may display signs of congestive heart failure, which according to (PetMD) includes: coughing, exercise intolerance, or general weakness.

What should I do if my pet has a murmur?

The short answer is, work with your veterinarian. There are so many different classifications and underlying causes for murmurs, that your veterinarian will need to help you determine if treatment is necessary, if there are any structural issues you should be worried about, and what you can do to help your pet.

Our dog Maui (who passed away in 2015) had a murmur since 2010, and lived a healthy and full life (she had epilepsy, but that wasn’t related to our knowledge). Maui was not on medication for any heart issues until she was diagnosed with heart failure in the fall of 2014. We miss you Mau Mau <3!

Maui

Have you ever had a pet with a murmur?

To learn more about heart murmurs, please visit Carol’s Fidose of Reality to hear her Mom perspective on this same topic!

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How to Administer Medication to Your Pet

Whether you are giving your dog medication temporarily or giving a pill for long-term treatment, administering medication to your dog is not an easy task. Not to mention, some dogs have become masters at avoiding medication and/or spitting it out when you aren’t looking.

As you can imagine, I have a lot of experience getting dogs (and cats) to take medication and there are a few things you can do to make administering medication just a little bit easier on you and your pet.

Food is your friend

If your dog is at all food motivated, the very first thing you need to know is that food is your friend when it comes to administering medication.

High Value Treat

If you have any experience training your dog, you may already know what they consider to be a high-value treat. For Rooney, it’s anything we are eating (he even gets excited about lettuce). However, for some dogs you might have to put in a little more effort to determine what they consider to be high-value.

Once you have determined your dog’s favorite high-value treat, you can use that information to help administer medication. For example, you could hide your dog’s medication in chicken or even some cheese. I prefer to use string cheese for small pills since you can stuff the pill into an already formed cheese stick. The more you coat the pill in the food you are giving, the more likely they are to eat the entire thing and the pill.

Make sure that you check ingredients before giving your dog medication in any non-pet food. I would avoid “diet” or “light” foods as they tend to use alternative (and sometimes unreadable) ingredients.

via GIPHY

Dog Safe Peanut Butter

Dog safe peanut butter is also a high value treat, and my go-to for feeding pets their medications. I mentioned dog safe peanut butter on my Facebook page a few months back and someone commented and asked what I meant by “dog-safe”. As it turns out, there are several peanut butter brands that contain xylitol, which is a very toxic ingredient for dogs (most often found in sugar-free gum). So make sure to check that your peanut butter doesn’t contain xylitol before giving it to your dog. Additionally, you can opt for an even healthier peanut butter option by switching to unsalted or homemade peanut butter (AKC).

The reason I like to use peanut butter to administer medication is because of the texture. It’s so sticky that dogs very rarely eat the peanut butter and spit out the pill because the peanut butter adheres together.

The Spoon Method

This recommendation is based on nothing but my experience. When I give Rooney a pill in peanut butter or cheese, I put it into a spoon. I find that when he has to bite down to get the food, which he does when I give it to him in a spoon, he tends to eat the pill a lot faster, and easier, because he isn’t licking the peanut butter or cheese out of a bowl for example, and carefully leaving the pill behind.

Pill Pockets

Pill pockets are designed to put a pill into the “pocket” of food and then easily close the food around the pill to make it more palatable for your dog. While I have never used these for Rooney, I had many clients who swore by their effectiveness and ease of giving their pet medication.

Make it Fun

If anyone has given their pet pills over a long period of time, they know many dogs will find a way to eventually leave the pill behind. Even when the most high-value treats are involved. Rather than handing your dog a random treat (with a hidden pill), and then moving on, you could make a training session or game out of it, which takes your dog’s concentration off of the treat and hidden pill.

Animal Behavioralist Patricia B McConnell suggests making the process of giving your dog medication fun. She suggests the 1, 2, 3 game outlined below.

The One Two Three Game: First, encase the pill in some highly palatable food, perhaps a piece of chicken or some peanut butter. Put it aside and give the dog a treat with no pill. Then give the dog a second treat. Next, pick up the treat-encased pill and put it right next to your dog’s nose, but don’t let him eat it! Pull it away, as if to tease him. Move it within an inch of your dog’s nose/mouth again and snatch it away a second time. Move it a third time toward your dog’s mouth and let him eat it. Follow it up with a fourth treat, this time with no pill. Unless the pill is truly noxious, this works really well and makes the entire exercise great fun.

I love the idea of getting your dog to play with you as part of administering medication rather than making it a forced situation. She also suggests using natural competition to your advantage if that motivates your dog, and is an available option for you. Dr. McConnell further outlines that process in her blog post here.

Opting for Liquid or Chewable Medication

A lot of medications can be compounded these days which allows you to give your dog flavored medication on top of their food (this is also a great option for cats), or as a treat. Unfortunately, not all medications can be administered in liquid form, so this isn’t an option for every one, but definitely something you can ask your veterinarian about.

Other Methods

Manually Giving the Pill

You can give your dog a pill by placing it as far back in their mouth as you can. I wouldn’t recommend this unless you have taken the time to try other methods, none of which have worked for you, and you are now in a situation where the medication is imperative to your dog’s health and well being and, therefore, you need to give the pill manually. If you are going to do this, make sure that you get a demonstration and further instruction from your veterinarian or veterinary technician. They will be able to show you exactly how you should administer the pill to your pet, so that you can avoid some common mistakes that pet parents make.

Stay Positive

If you can, try to stay positive about the experience. While giving your pet medication can be difficult, and at times, frustrating, rely on your veterinarian and their team to help you develop a solution. If you are going to give your pet a pill often, you don’t want them to have a negative experience. Adding food and positive reinforcement wherever possible will definitely help.

For more info on how to give your pet their medication, hop on over to Fidose of Reality for Carol’s Dog Mom perspective.

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The Difference Between Obesity and Hypothyroidism

Welcome back for another edition of Medicine Versus Mom. While working at the veterinary hospital, I can’t tell you how many overweight pets we had as patients. Statistics would tell you that at least 50% of our patients were overweight and had a poor body condition score. While some pet parents seemed oblivious that their pet’s weight was not ideal, others knew that their dog was gaining weight, but felt that they were doing all the right things (not overfeeding, and providing regular exercise). This issue among pet parents is so common that Carol Bryant from Fidose of Reality and myself thought we would discuss it here today.

Specifically, we want to talk about understanding the difference between canine obesity and hypothyroidism. While both of these diseases are highly treatable in dogs, they do have similar symptoms which could lead to misdiagnosis or assumptions from pet parents about how to improve their dog’s health. I believe that by understanding hypothyroidism and it’s symptoms, you will be able to better understand when your dog needs to have endocrine testing versus needing diet and exercise changes.

What is Hypothyroidism?

According to PetMD: 

“Hypothyroidism is a clinical condition resulting from a lowered production and release of T4 and T3 hormones by the thyroid gland. It is common in medium to large-sized dogs, with some being more predisposed than others. “ 

When the production of the T3 and T4 hormones decreases, it causes the processes and the functions of all organ systems in the body to slow down. Including, your dog’s metabolism. Hypothyroidism is commonly diagnosed between the ages of 4 and 10 years old, and some breeds (listed below) are more prone to the disease than others:

  • Golden Retriever
  • Doberman Pinscher
  • Irish Setter
  • Miniature Schnauzer
  • Dachshund
  • Cocker Spanial
  • Airedale Terrier

What are the symptoms associated with Hypothyroidism?

According to the Merck/Merial Manual for Pet Health, the symptoms associated with hypothyroidism include:

  • Lethargy
  • Unwillingness or inability to exercise
  • Weight gain
  • Dry coat or skin
  • Excessive shedding
  • Hair thinning or hair loss
  • Reoccuring skin infections

What causes Hypothyroidism to occur?

According to PetMD, hypothyroidism usually occurs because the thyroid gland has been destroyed by an abnormal immune reaction. In most cases (95%) hypothyroidism is due to the destruction of the gland itself, however, in a small number of cases it is due to a tumor of the pituitary gland (Merck/Merial Manual for Pet Health).

How is Hypothyroidism diagnosed?

Traditional diagnosis requires endocrine testing (measuring the amount of thyroid hormone your dog has available) of the T3 and T4 hormones.

What is the treatment for Hypothyroidism?

Traditional treatment for hypothyroidism requires providing your dog’s body with the synthetic version of the hormone they are lacking.

The deficient hormones are given in synthetic form, with the dosage adjusted occasionally based on your dog’s individual physical condition and progress. Most clinical symptoms will resolve after a few months, but only your veterinarian can determine whether your dog’s medicine dosage should be adjusted or changed. To avoid complicating the condition, do not change the type or dosage of the drug yourself, and never give anything new to your dog without first consulting with your veterinarian. This caution includes the use of herbal remedies.- PetMD

How to know when its just weight gain…

When I was studying Animal Science at UC Davis, I specifically remember learning that Hypothyroidism, while not a rare disease, was being over diagnosed in veterinary medicine. In an article written by Dr. Patty Khuly in 2008, she alluded to the over-diagnosis of this disease mostly based on the idea that people didn’t want to admit that their pets were simply gaining weight.

Not only do I find this disease of slow-metabolism to be one many of us humans wish we had (especially when at a loss to explain why we gained so much weight over the holidays)—hypothyroidism is an illness pet owners increasingly want their overweight pets tested for.

I can’t blame pet parents for wanting their dogs to be tested for hypothyroidism, especially when they feel that they have done all of the right things to care for their dogs. But, if your dog’s hormones are balanced, we don’t want to give them medication they don’t need.

So, how can you be sure that your dog is receiving the right diagnosis?

According to Dr. Jennifer Coates, if your dog has symptoms associated with hypothyroidism, and bloodwork has revealed low thyroid levels, and all other clinical signs have been ruled out, then it is appropriate to tentatively diagnose your dog with hypothyroidism. The true test will be your dog’s responsiveness to the medication. If repeat testing shows that your dog’s hormone levels have returned to normal, than your dog is truly hypothyroid and should continue on the medication per your veterinarian’s recommendations.

Misdiagnosis can occur for a variety of reasons:

Because dogs that are sick with diseases completely unrelated to the thyroid gland often develop low thyroid hormone levels. The condition is called euthyroid sick syndrome, and it does not require thyroid hormone replacement therapy. What is really needed is an accurate diagnosis and treatment aimed at the underlying problem, but this is sometimes easier said than done!

In conclusion, it is important for pet parents to be honest with themselves. Is your dog gaining weight? Or are there other symptoms on this list your dog is experiencing? Have you tried adjusting their diet and exercise? Is someone else in your house overfeeding your dog (you would be surprised how often this happens)?

If you truly feel that your dog is experiencing symptoms of Hypothryoidism, definitely take them to visit your veterinarian and be prepared for bloodwork testing.

I highly recommend visiting Fidose of Reality to hear Carol’s Dog Mom perspective on this topic!

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Cold Laser Therapy for Dogs: A Revolution in Arthritis Treatment

There is a new-ish treatment available in veterinary medicine, and it’s called Cold Laser Therapy!

I am very excited to share with your some information about Cold Laser Therapy along with my good friend Carol Bryant from Fidose of Reality. Carol’s dog Dexter has been treated with Cold Laser Therapy, so she will be able to share her Mom perspective on the topic, while I provide you with some general medical information regarding this new and exciting treatment.

What is Cold Laser Therapy?

It’s a type of treatment where “a cold laser uses a beam of light to stimulate damaged cells to produce more energy” (Veterinary General). When the laser stimulates the cells, it improves cellular function, reduces inflammation, and stimulates blood flow. Additionally, Cold Laser Therapy improves the absorption of nutrients by the cells and cellular reproduction. What most pet parents need to understand is that the most common joint damage that our pets experience is due to cellular damage, inflammation, and a lack of healthy cell reproduction. Specifically arthritis, which is defined by PetMD as:

Arthritis is a general term for abnormal changes in a joint. It can arise from joint tissue destruction after an infection, from congenital defects affecting structural architecture, and from stress and trauma to joint surfaces and supporting structures.”

Due to its positive effect on cellular tissue, Cold Laser Therapy can be used to treat the following (Veterinary General):

  • Arthritis or Musculoskeletal diseases
  • Joint injuries or Trauma
  • Post-Surgical incisions
  • Ligament or tendon injuries
  • Fractures
  • Muscle sprains or strains
  • Skin lesions or abrasions
  • Nerve damage

New-ish to Veterinary Medicine

Cold Laser Therapy is new-ish to veterinary medicine. Much of the initial research in the media was published around 2011 from my findings. However, according to Multi Radiance Medical, Cold Laser Therapy gained popularity in the veterinary rehabilitation community in the 1990s. Despite being a new-ish treatment, Cold Laser Therapy has been around in human medicine for quite some time.

“Laser therapy is a very effective modality to speed and direct healing in dogs with painful arthritis, strains and sprains and other injuries or effects of aging. It has been used in humans for a long time and dogs now can reap the benefits, too.” – Dr. Christine Zink Director of the Department of Molecular and Comparative Pathobiology at Johns Hopkins School of Medicine

What does this mean for you?

Veterinary Medicine has spent many years determining the effects and applications of Cold Laser Therapy. As the treatment continues to gain popularity in the veterinary field, your pet will have better access to improved technology.

What to Expect

Veterinarians who are trained in rehab therapy will be able to recommend the Cold Laser Therapy to your pet as part of a larger treatment plan.

Your veterinarian may recommend Cold Laser Therapy as a treatment for your pet if they suffer from a joint or ligament injury or condition. The reason that Cold Laser Therapy benefits your pet is that it is non-invasive treatment, with no recovery time. Meaning, there is no anesthesia necessary, and often, you can be with your pet during the treatment (Veterans Memorial Drive Animal Hospital).

Once your veterinarian recommends Cold Laser Therapy for your dog, you and your pet will visit the veterinary hospital for regular visits. While in the hospital, your pet will lie down and the laser will be applied to the targeted area. You may need to visit more frequently in the first few weeks until your dog reaches maintenance (Veterans Memorial Drive Animal Hospital).

Many positive stories surround the use of Cold Laser Therapy in pets. Some pet parents say their pets joints seem brand new! Others see a marked difference in the way their pet walks. Either way, it seems as though many pet parents have had a positive experience with Cold Laser Therapy.

The Skeptics

Of course, with new treatments, there will be skeptics, which is a good thing. In my opinion, the more questions that are being asked, the better the technology and research will become.

  • “Not all cases are successful.” As of 2012, some studies do show that Cold Laser Therapy is not always successful. However, due to the number of parameters and variables that can skew the research, these studies do not indicate that Cold Laser Therapy is ineffective. (Veterinary Practice News)
  • “The lasers only reduce pain, nothing else”. This is false, due to the increased circulation, Cold Laser Therapy can also improve ligament and cartilage function, as well as, decrease inflammation. (Veterinary Practice News)

To learn more about common myths associated with Cold Laser Therapy, I highly recommend reading this article from Veterinary Practice News.

Items of Note:

Based on my research, I wanted to share with pet parents a few quick items of note:

  • Not recommended for pets who have cancer because the treatment can stimulate the blood flow near cancer cells. (ABCNews)
  • There are different classes of lasers. According to Dr. Karen Becker, Class IV lasers, which are the strongest, were approved but the FDA in 2011 and are 50 times more powerful than their Class III predecessor. Additionally, new lasers have adjustable power output so that you can adjust for different types of treatment.
  • Class IV laser therapy treatments are cumulative, meaning each treatment builds on prior treatments and the animal’s condition improves continuously.” – Dr. Karen Becker
  • The treatment can reduce the probability of re-injury (Dr. Karen Becker)

Do you have or know a pet who could benefit from Cold Laser Therapy? If so, share with them this information and check out Carol’s Mom perspective on Cold Laser Therapy.

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Do You Know Your Pet’s Vitals?

The answer to this question may not seem important now, but at some point most pet parents will need to know their pet’s vitals to be able to monitor their health and know when they need treatment.

Today, Carol from Fidose of Reality and I, are going to share with you some important information about your pet’s vitals so that you can protect your pet’s health, should concerns arise.

Temperature

For both dogs and cats, a normal temperature is between 100 and 102.5 degrees Fahrenheit. (VetStreet)

The most common way that a dog or cat’s temperature is measured by veterinary professionals is using a digital rectal thermometer. Unless it is recommended by a veterinarian, you shouldn’t need to take your dog or cat’s temperature at home. However, if you are instructed to do so by your veterinarian, you can find more information on how to measure your dog’s temperature at home in this VetStreet article.

If you take your pet’s temparture and it is outside of the normal range and you see evidence of diarrhea or bloody stool, contact your veterinarian immediately. 

Heart Rate

Heart rate varies significantly from one pet to the other. According to VetStreet, a dog or cat’s heart rate can vary anywhere from 60 to 140 beats per minute. A faster heart rate will often be found in a small dog, a puppy, or a dog who is not in very good shape. Because I check on Rooney’s heart rate, I know that his tends to be a bit on the faster side.

How to check your dog’s heart rate?

You can check your dog’s heart rate in two ways.

You can feel your pet’s heart rate by gently placing your hands on their chest, or you can feel their heart rate through their femoral artery located in their thigh (see photo).

Respiratory Rate

Respiratory rate is a really important measurement for a pet parent to know. It’s a clear indicator of your dog’s discomfort and can help you determine an emergency if you dog is at risk for overheating.

If your dog is panting frantically and is glassy-eyed, don’t count anything except the minutes it will take you to get to a veterinarian. Your dog is in critical condition from overheating. – VetStreet

A dog who is at rest should breath somewhere between 10 and 35 breaths per minute. If your dog is panting and the symptoms are combined with the description above, you may be in an emergency situation.

Vitals Monitored by Your Vet

Do You Know Your Pet's Vitals?

Photo credit: http://www.vmdtechnology.com

While the top 3 vitals are the most important for you to know as a pet parent, I want to share with you some other important information that is typically monitored at the veterinary hospital. The chart above is an example of how your pet’s vitals might be tracked if they are being hospitalized. To provide some additional transparency for pet parents, let me discuss what a few of these items mean.

Attitude

BAR stands for Bright, Alert and Responsive. This means that your pet entered the hospital looking like they feel okay; tail-wagging, normal energy, and behavior. Another descriptor that could be used here is NDR, which stands for Not Doing Right. This description might be used to describe a pet who seems lethargic, unresponsive, and sick. (PetMD)

MM = Mucous Membranes

Specifically, veterinarians and their technicians are looking at the color of your pet’s mucous membranes. If you want to check your pet’s mucous membranes, all you need to do is gently lift their lip and check their gums. You want to see bright and pink mucous membranes (i.e. gum tissue).

What you don’t want to see are membranes that are grey, white, purple, or tacky.

CRT

While checking your pet’s mucous membranes, your veterinarian or veterinary technician will also check your pet’s CRT, which stands for Capillary Refill Time. The best way I can explain how to measure your pet’s CRT is to gently press on their gums and see how long it takes the color to return (like checking a sunburn). If it takes 2 seconds or less to refill, your pet is within the normal range. However, if it take more than 2 seconds, then it is considered an abnormal CRT which might be indicative of dehydration, lack of blood flow, or lack of oxygen.

Other Metrics

While your pet is in the hospital, it is really important that someone is keeping track of their walks, water and food intake, and urination and defecation. Not only does this type of documentation make sure that every pet in the hospital gets the appropriate care no matter how busy things get, but it also provides your veterinarian with some additional insights regarding your pet’s health.

Knowing When You Can Monitor & When It’s an Emergency

Emergencies happen. As a pet parent, I am a fan of the phrase, “when in doubt, call your veterinarian”. You know your pet best and if you feel like their behavior, disposition, or overall health has changed (i.e. vomiting, diarhhea, increased or decreased urination, water intake, food intake, or defecation), call your veterinarian or emergency veterinarian.

However, at some point in your pet’s life you might need to monitor their vitals and their overall health. You should always do so with the guidance and direction of your veterinarian. That being said, I believe that knowledge is power. Knowing what the parameters of your pet’s health should be will make you that much more informed as a pet parent.

For more important information, and to read Carol’s Mom perspective on this topic, please visit Fidose of Reality.

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