732-528-9199

Bot Fly Larvae in Dog in Manasquan, NJ

Bot Fly Larvae in dog in Manasquan, NJ

 This is an interesting, although somewhat gross, case of a fly larvae living inside a dogs skin and then popping out to hatch.

Bot Fly beforeSurgical Extraction of fly larvae at Squan Animal HospitalSurgical Extraction of fly larvae at Squan Animal Hospital

There are 34 species of bot fly larvae in North America, their scientific name is Cuterebra. They usually infect rabbits and rodents, although occasionally larvae mistakenly infect dogs and cats. The adult is a fly that looks like a bee, but doesn’t sting. The adult only lives a short time and it’s main goal in life is to lay eggs by rabbit and rodent burrows. The eggs hatch into larvae and are ready to attach to a passing animal to continue their life cycle.

While a dog or cat is rooting around a rabbit or mouse den a larvae can attach to the pet and enter the pet through the nose or mouth. Contrary to popular belief the bot larvae do not burrow through intact skin. The larvae will migrate inside the body and cause one of three syndromes:

  1.  1. Larvae can migrate to the brain, especially in felines, and cause neurological signs like circling, seizures, blindness or behavior changes. This is the typical cause of Feline Ischemic Encephalopathy.

 2. Larvae can migrate in and around the lungs and trachea causing respiratory signs.

 3. Most commonly, larvae eventually migrate to the skin and form a warble, or swelling where the larvae make a breathing hole. (See picture above) The larvae will grow and mature here, then pop out as a maggot 3-6 weeks later to burrow in the soil. In the soil they pupate into an adult fly to continue their life cycle.

Treatment of bots in the skin of pets is simply by extracting them surgically. (See picture above) Oftentimes the opening needs to be made bigger so the larvae can be pulled out intact. If the larvae breaks apart under the skin an allergic reaction can occur. Treatment of larvae in the brain of cats depends on a case by case basis, but usually requires an MRI for diagnosis and a variety of drugs for treatment. Treatment of respiratory cuterebra also involves a variety of drugs.

For more detailed information on Cuterebra in pets see http://www.capcvet.org/capc-recommendations/cuterebriasis

 

Squan Animal Hospital LLC
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com
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Snuggles’ Success Story

Snuggles

Hi my name is Snuggles. I am a 13.5 year old pug who was given 6 months to live 2 years ago, today. See I have been fighting for my life for over 5 years now. It started with having been diagnosed with Mast Cell Cancer and Diabetes back in late summer and fall of 2008. Then, 5 months later I developed Cataracts from the diabetes. Mommy opted for cataract surgery immediately and after surgery I developed 4 different types of eye infections that caused me to go fully blind. Two years after the cataract surgery I was told I have Glaucoma in my left eye from the surgery. One month later I got the worst news of all. No matter what mom was doing for me my blood glucose reading was all over the place in a 2 month period so we opted for an X-ray, ultrasound and blood work. Both showed my liver shrunk so tiny and the blood work showed my bile acid numbers were off the charts. The Internist told us I was in Advanced Liver Disfunction. They explained that I was to old for a biopsy to determine the cause and due to the severity I would have a life expectancy of 6 months. There was nothing else they could do for me other then treat individual symptoms as they show themselves. Then, the list grew and 1 year ago they diagnosed me with Chronic Bronchitis. Well, with lots of tender love and care and persistence from my mom and my favorite veterinarians Dr. Levin and holistic vet Dr. Paul, also thanks to amazing holistic and homeopathic remedies and diet change I stand here with you today, 2 years later, cancer free, my diabetes, glaucoma, advanced liver disfunction and chronic bronchitis are all under complete control and I am still fighting strong. Please have faith and bring out the fight in you… It extended my life and yes I am very comfortable!!! Love and Hope everyone.

 

 

 

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Allergy Control for Sonny a Yellow Labrador from Brick, NJ

Allergy Control for Yellow LabradorPictured is Sonny, a 8 year old Yellow Labrador from Brick, New Jersey. Sonny suffers from allergies and is currently using Desensitization Injections to help control his allergies.

 

Allergy Control In Dogs Using Desensitization Injections

This discussion is limited to Atopy and only one specific treatment-desensitization injections to allergens.

Dogs can generally have three classes of allergies:

1) Atopic Dermatitis (Atopy)- These allergies are usually related to environmental allergens that trigger an allergic response by direct contact or inhalation.  These allergens include grasses, pollens, trees, weeds, molds, house dust mites, fabrics and others.  Often times atopy is worse at certain seasons when the specific allergen is prevalent in the environment, but over time can become year round.  Common signs are red, itchy, infected paws, skin and ears. 

2) Food- These allergies are usually related to specific ingredients in food, like certain proteins such as chicken or beef.

3) Insects- These allergies are commonly caused by biting bugs such as fleas, biting mites or flies.

With atopy, after exposure to specific allergens the immune system responds (or over responds) by producing chemicals such as interleukins, histamines, and others that cause skin redness, inflammation and itching, which allows yeast and/or bacteria to cause a secondary infection.  This sets up a vicious cycle of more itching and inflamed skin. 

An intradermal skin test or blood test can check for 50 or more specific allergens common in our area of the country.  Each allergen has a “score” of how allergic it is to the dog.  Those allergens with high scores are combined in a small vial specifically designed for your allergic dog.   Every three weeks you give a very small injection of the allergy solution under the skin of your dog.  By giving frequent injections of small quantities of allergens to your dog it will boost their immune system specifically to those particular allergens.  So then when the dog is naturally exposed to those allergens the immune system will help neutralize them, thus minimizing an outbreak. 

The allergy injections could take 2-6 months or sometimes more to start working.  In general 75% dogs are helped quite a lot by the injections and the dog owners are satisfied they went through with the treatment protocol.  The injections are easy to give and painless for the dog.  We make sure you can administer them properly in the exam room.  For more detailed information click here.

VARL Allergy Serum

 

Environmental allergies like to come back month after month and year after year, which is very frustrating for the dog, owner and veterinarian.  So if you would like to discuss if your allergic dog has atopy and the desensitization injections, just give a call or make an appointment with the veterinarians at Squan Animal Hospital in Wall NJ.

Squan Animal Hospital LLC
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com
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Avon, New Jersey Cat Diagnosed with FIV

FIV IN CATS

Avon, New Jersey Cat with FIVPictured is Henry an 8 year old Domestic Shorthair Cat from Avon, New Jersey that has been diagnosed with FIV.

FIV

FIV stands for Feline Immunodeficiency Virus, which only affects cats.  The virus is common worldwide.  It’s highest prevalence is in cats that go outdoors, stray cats, and barn cats, especially in adult male cats and cats that fight/bite each other.   The virus is very short lived outside of the cat.

Mode of Transmission:

The most common way FIV is transmitted is directly through saliva from bite wounds from infected cats.  Less common ways are blood to blood, or from infected queens to their kittens. 

Clinical Signs of Disease:

Following infection most cats have no signs of illness for years.  Many cats with FIV will live a happy healthy life for 5-10 years or more.  Over time the immune system is compromised and doesn’t function as well as it should, predisposing cats to secondary infections.  Signs of FIV infection are varied, but can include:

General lethargy, oral lesions and sores in mouth, eating less, losing weight, fever, large lymph nodes, other infections, lymphoma, as well as many other signs.

Testing:

Most affected cats will test positive on a routine antibody test within two months of exposure.  Occasionally false positive results occur, in which case the cat should be tested again weeks later, or a confirmatory test can be run-like the Western blot test.  Cats vaccinated for FIV will turn up positive on current FIV tests.   Veterinarians are currently working on tests to differentiate a previously vaccinated cat from a truly infected cat.

Vaccine for FIV:

A vaccine commercially exists for FIV, but veterinarians rarely give it because of effectiveness concerns and that vaccinated cats test positive on FIV tests.

Treatment:

Isolation of FIV positive cats in households where cats get along and don’t fight is no longer considered necessary.  If there is a risk of fighting and biting then isolation is best.  Keep the affected cat indoors to minimize chance of virus spread to other cats and to prevent secondary infections in your affected cat.  Drugs that stimulate the immune system generally don’t help but interferon alpha may provide some benefit.  The human HIV drug AZT may help cats showing signs of infection. 

 

More Information:

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1313

http://www.vet.cornell.edu/fhc/brochures/fiv.html

 

If you have an indoor/outdoor cat, call and schedule your appointment today. Please do not hesitate to get in touch! We will make it the best experience possible for you and your four legged friend!

 
Squan Animal Hospital LLC
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com
 
 
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Squan Animal Hospital Treats Belmar, NJ Black Labrador with Arthritis

Arthritis in Dogs

Belmar, NJ Black Lab with ArthritisPictured is Kody, a Black Labrador from Belmar, NJ who has arthritis and is doing well with treatment.

What is arthritis?

When we discuss osteo-arthritis (OA) in dogs we usually think about the leg bones and joints-like elbows, shoulders, knees and hips.  The ends of bones in joints are covered with a nice smooth layer of cartilage, that is bathed in a lubricating joint fluid which is surrounded by a joint capsule preventing any leakage.  The bone/cartilage ends mesh and align perfectly.  When the dog walks or runs and the joint moves and bends,  the bones/cartilage slide past each other in a smooth, low friction gliding motion.  A disruption to this normal anatomy and function can lead to inflammation occuring in the joint, changes in the joint fluid lubricating properties, and the cartilage eventually can become roughened and pitted thus losing  it’s nice smooth surface.  Inflammation, cartilage destruction, and pain occur.  As the degenerative condition progresses and gradually gets worse, bony changes can occur which can be detected on x-rays.

Causes of arthritis:

The causes of arthritis are very long and varied. 

1) Developmental  and congenital abnormalities, such as hip dysplasia and elbow dysplasia in large breeds, where the bones don’t perfectly mesh and come together.  Luxating patellas in small breed dogs, where the knee cap is very loose.

2) Immune mediated processes, where the immune system goes awry from a whole variety of reasons and affects or attacks the joint cartilage and joint fluid.  Rheumatoid arthritis is a classical human example of immune mediated erosive arthritis, but less common in dogs.

3) Infectious diseases, such as Lyme disease and other bacteria that can be transmitted by ticks can cause OA.  Other non tick related bacterial infections can affect the joints.   Viral, calicivirus in cats.

4) Aging and/or obesity can put extra strain, stress and wear and tear on the joints thus promoting OA.

5) Injuries, such as a ruptured cruciate ligament in the knee.

6) Other factors.

 

Signs of OA:

Limping, favoring a leg, stiff, sore, slow.

Difficulty or reluctance to stand up.  Difficulty or slow with stairs.

Painful,  behavior changes.

 

Diagnostics, radiographs (X-RAYS):

Physical exam and questioning by the veterinarian, gives valuable information.  As OA advances bone changes can be seen on radiographs. The elbow joint on the left is a normal elbow. The elbow on the right is a severely arthritic dog elbow, with lots of bony spurs and joint swelling.

 Normal Dog Elbow JointOA Elbow Joint in Dog

 

 

 

 

 

       

 

Treatment:

Keep your dog fit and trim and in good body condition.  Low and medium impact exercise like swimming, short jogs and long walks are good for mobility, muscle strength and joint health.  Heavy exercise is excessive and can lead to worsening of OA.  Neutraceuticals like glucosamine, chondroitin and fish oils can help maintain cartilage and joint fluid health.  As OA progresses Non Steroidal Anti-Inflammatory Drugs (NSAIDS) can be added in, aspirin is not very safe for dogs so veterinary types only must be used.  Acupuncture can help with pain and inflammation and keep dogs with OA walking better for a longer time. There are many other meds that can be used, contact your veterinarian for specifics.  Sometimes surgery can be done to slow the progression of arthritis, for example arthroscopic surgery for elbow dysplasia.  Overall the majority of dogs can lead a relatively normal happy life with OA.

 
Come check out our cozy office, get aquainted with our knowledgeable staff and schedule your appointment today, please do not hesitate to get in touch! We will make it the best experience possible for you and your four legged friend!
 
Squan Animal Hospital LLC
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com
 

 

 

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German Shepherd from Point Pleasant, NJ diagnosed with Pannus

PANNUS

Point Pleasant, NJ German Shepherd dog diagnosed with PannusPictured is Bridget an 11 year old German Shepherd from Point Pleasant, NJ in Ocean County, with Pannus.

What is Pannus?

Pannus is technically known as chronic superficial keratitis.  It is an inflammatory condition of the cornea of the eye in dogs that causes a red eye with a haze/film/inflammation on the cornea (keratitis), that tends to progress and  worsen with time.

Breeds Affected:Pannus Pic

Pannus is most common in German Shepherd dogs, where it is thought to be an inherited condition that usually manifests itself between 3-5 years old.  Usually both eyes are affected.  Other breeds such as Greyhounds can also get pannus. 

Besides breed, there may be a triggering link to ultraviolet sun light exposure and high altitudes, as it seems more common with these factors.

Cause and Progression of Pannus:

It is classified as an immune mediated disease, an autoimmune disease, where the body’s immune system goes awry and attacks it’s own cornea.  It usually starts at the edges and the result is that small blood vessels, granules and connective tissue migrate across the cornea and accumulate in plaques of tissue that may be grey-pink, brown or become black.  Often times the third eyelid becomes thickened and inflamed, as well as inflammation  and conjunctivitis on the conjunctiva just above the eye.  Oftentimes there is a mucous discharge associated with pannus. Pannus can affect vision and eventually lead to blindness if not treated.

Treatment of Pannus:

Treatment involves trying to locally suppress the immune system from continuing damage to the cornea and treating to decrease inflammation.  Steroids such as prednisolone acetate or dexamethasone eye drops are commonly used.  Other immunomodulating eye drops such as cyclosporine or tacrolimus, sometimes used in conjuction with steroids can give good control.  The goal is to keep inflammation and keratitis at bay and quiet, to prevent worsening of lesions, and of course to preserve vision.  Treatment is usually life long.  Some dogs who do not let their owners put in eye drops can get steroid injections in the conjunctiva just above the eye monthly to help control pannus.  Trying to avoid direct sunlight for long periods of time, especially when the sun is directly overhead may also help control the disease.

 

Just like their owners, our four legged friends need there eyes examinedContact our office today to schedule your dogs next exam.

Squan Animal Hospital
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com

 

 

 

 

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Wall, NJ Mixed Breed Dog Has Epileptic Seizures

Wall Township, NJ Mixed Breed Dog Has Epileptic SeizureSeizures in Dogs and Cats

Pictured is Sandy, a 3 year old, Mixed breed dog, from Wall Township, NJ.  Sandy was adopted from Wag on Inn Rescue almost 2 years ago. She has epileptic seizures.

What are seizures?

Seizures in felines and canines are abnormal brain activity, and nerve cell firing that are usually manifested as a sudden onset of convulsing.  Common signs of a grand mal seizure may include one or more of the following: uncontrollable shaking, convulsing, stiffness, chomping at the jaw, salivating, urinating, paddling while laying on side and being mentally  “out of it” unaware of surroundings.   Pets can also have partial or focal seizures that may manifest as facial or leg twitching.  Seizures generally last up to 2-3 minutes, then the pet enters the post-ictal (after seizure) phase.  This phase may be absent entirely, may last a few minutes or possibly hours.  Pets in the post-ictal phase may be temporarily blind or disorientated, then they usually quickly get back to normal.

Causes of Seizures

The most common cause of seizures is epilepsy, which is a genetic predisposition to seizures, or idiopathic epilepsy where seizures just occur without any identifiable underlying cause.  Epilepsy usually occurs in cats and dogs between 6 months of age and 6 years.  If seizures occur in pets younger or older than that, then there is a high likelihood that there is an underlying cause beside epilepsy.  Other causes of seizures may include liver disease, low sugar levels in the blood, inflammatory conditions in the brain (GME), increased pressure in the brain, a variety of infections-viruses, bacteria and parasites, toxins, trauma, structural lesions in the brain, space occupying lesions in the brain and brain tumors, especially in older animals. 

Diagnosis

Age of pet, history of pet and specifics of seizures usually give the veterinarian a strong clue if it is due to epilepsy or not.  Blood work and X-RAYS may typically be done to help diagnose the cause of seizures, but an MRI of the brain by a veterinary neurologist is oftentimes needed for a definitive diagnosis and treatment course.

Treatment

For epilepsy usually one or both of the drugs,  Potassium Bromide or Phenobarbital, are usually used as first line drugs to decrease the severity and or frequency of seizures.  These medications usually have a very good success rate.  Treatments for the other causes of seizures are specifically tailored to the particular underlying cause.

Prognosis

Usually the prognosis is very good for controlling epileptic signs, but can be variable.  Prognosis varies widely for other cause of seizures.  For old cats with meningioma tumors in the brain prognosis is excellent with surgical removal.

 
If You Would like More Detailed Information on Seizures please check out the link below!

General seizure information: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=560

 
Come check out our cozy office, get aquainted with our knowledgeable staff and schedule your appointment today, please do not hesitate to get in touch! We will make it the best experience possible for you and your four legged friend!
Squan Animal Hospital LLC
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com

 

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Wall Township, NJ Pug Has Cataract Surgery To Restore Vision

 Wall Township, NJ Pug has Cataract surgery to Repair VisionCataracts: Meet Snuggles, a 12 1/2 year old pug from Wall, Township NJ, who had cataracts from diabetes and had cataract surgery to restore vision.

What Are Cataracts?

Cataracts are when the lens in the eye becomes opaque (less transparent) to light.  This can result in less or no light hitting the retina in the back of the eye and decreased or loss of vision. (See diagram)  Cataracts can be small and mild, known as immature cataracts only partially affecting vision.  Cataracts can also be very opaque and not allow lights passage, known as mature cataracts, which may result in blindness.  Cataracts must be differentiated from nuclear sclerosis, a normal aging change of the lens, by a veterinarian.  Nuclear sclerosis is a grayish-blue haze to the lens that pet owners sometimes notice and confuse with cataracts, vision is normal with nuclear sclerosis.Eye Diagram for Cataracts

Causes of Cataracts:

There are many causes of cataracts including genetics and breed.  For example some retrievers, spaniels and terriers are prone to developing cataracts.  Old age (senile) cataracts can be seen in older dogs especially small breed dogs.  Diabetes in dogs, but not cats, is a very common cause of cataracts. Most diabetic dogs become blind within a year or so of diagnosis, even with proper insulin therapy.  Other causes include trauma to the eye, inflammation and infection of the eye, poor nutrition in puppies and radiation therapy among other causes.

Cataract Signs:

Signs you may notice are a decrease in vision, especially night vision, or you may notice the pupil looks “white”.  If you think you notice these signs you should bring your pet to a veterinarian for a comprehensive diagnosis.

Cataracts Treatment:

The treatment of choice for cataracts is surgical removal of the cataract performed by a veterinary ophthalmologist.  Phacoemulsification is a procedure using a specialized ultrasonic instrument to break up and remove the cataractous lens.  Usually an artificial lens is implanted to replace the removed one.  Surgical complications are discussed with the ophthalmologist ahead of time, but most dogs go on to have good vision after the procedure.

To schedule your appointment today, please do not hesitate to get in touch! We will make it the best experience possible for you and your four legged friend!

Squan Animal Hospital LLC
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com
 
 
 
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Squan Animal Hospital Treats Spring Lake, NJ Bichon Frise For Bladder Stones.

Urinary Bladder Stones (Uroliths) in Cats and Dogs

Spring Lake, NJ Bichon treated for Bladder Stones at Squan Animal HospitalPictured is “Snowball”, a Bichon Frise from Spring Lake, NJ with bladder stones.

Cats and dogs can actually get “stones” in their urinary bladder.  They form by minerals in the urine precipitating out of solution and condensing into a hard stone(s), known as a urolith(s).  Click on the X-RAY to see stones in a urinary bladder.

Xray of Bladder Stone in Dog Wall, NJ

 

 

What Are Bladder Stones?

Uroliths can form in any breed of cat or dog, although Dalmations and small breed dogs in general have a higher incidence.  Besides genetics, other causes of stone formation can be related to diet, persistent urinary tract infections, low water consumption, some disease conditions such as liver shunts and unknown factors.

How Do I Know If My Pet has Bladder Stones?

Signs of uroliths your cat or dog would exhibit may include frequent or painful urinations, blood tinged urine, straining to urinate, small volumes of urine or a thin urine stream.  Since other medical conditions can have similar signs you should bring your pet to a veterinarian to perform a physical exam, a urine analysis, and blood work along with X-RAYS as needed to determine a diagnosis.  If a stone gets caught in the urethra causing a blockage, this is a medical emergency.

Treatment

Treatment of uroliths varies on a case by case basis.  Occasionally a diet change can help dissolve stones, but many pets, especially those with large uroliths require a surgical procedure to remove the stones from the urinary bladder.  The stones are sent to a laboratory for analysis to determine their composition.  Once that is known, then diet changes or medications can reduce the chances of them forming again, but despite our (and your) best efforts oftentimes the uroliths return.  Follow up urine tests and X-RAYS can determine if they are reforming.

What are you waiting for? To schedule your appointment today, please do not hesitate to get in touch!  We will make it the best experience possible for you and your four legged friend!

 

 Squan Animal Hospital LLC
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com

 

 

 

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Ocean NJ Springer Spaniel Treated For Kidney Failure At Squan Animal Hospital

Kidney (Renal) Failure in Dogs

Ocean, NJ Springer Spaniel Treated for Kidney Failure at Squan Animal HospitalPictured is Emma, a 12 year old Springer Spaniel, who lives in Ocean NJ. She has recently been diagnosed with kidney failure due to a bacterial infection.  A culture and sensitivity test performed at Squan Animal Hospital directed us to the proper antibiotic choice and she is currently improving and we are hoping for a full recovery.

What is Renal Failure? 

The body has two kidneys to filter the blood removing toxins to be excreted in the urine.  Kidneys also preserve nutrients like glucose, proteins and electrolytes for the body to use.  Animals can function with one kidney.  In fact more than 67% of kidney function must be lost before toxins build up in the body and become detectable on a blood test.  The pet may feel sick.  Signs you may notice can include drinking or urinating a lot, decreased appetite, weight loss and lethargy.  If you notice any of these signs in your pet a veterinarian will run tests such as blood and urine tests to start off with and possibly cultures, X-Rays, ultrasound, and/or biopsies may be needed.

What caused my dog to be in Kidney Failure?

Causes of kidney failure include drugs and toxins, such as advil, antifreeze and eating grapes. Bacterial infections in the kidneys and systemic infections such as Lyme disease can cause kidney failure. A partial list of other causes include cancers, inflammatory diseases, inherited conditions, and old age can all affect the kidneys.  Due to the many different causes, outcomes vary on a case by case basis.

Please visit Kidney Failure for more detailed information.

Conclusion

This Ocean, NJ Springer Spaniel was diagnosed & treated here at Squan Animal Hospital. She’s now able to relax comfortably on her front porch and enjoy her family, while only having to check in with us every so often for blood tests to monitor kidney levels. For the past few years Emma has also received Acupuncture Treatments to help with her long standing Arthritis. Once her kidney disease was identified, Dr. Varga, a certified Veterinarian and Acupucturist, incorporated general support for Emma’s kidneys into her treatments, which also helped to stimulate her appetite. 

If you’re dog seems uncomfortable, please do not hesitate to get in touch!  We offer a warm, cozy, quaint environment with individualized veterinary service & care for your pet.

 
Squan Animal Hospital LLC
1427 Lakewood Rd
Manasquan, NJ 08736
Phone: 732-528-9199
Fax: 732-528-0769
E-Mail: cs@squananimalhospital.com

 

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